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Published on: September 19, 2015
Current Surgical Practice for Children Born with a Cleft lip and/or Palate in the United Kingdom
Matthew Fell1, Alex Davies2, Amy Davies1
1The Cleft Collective, University of Bristol, Bristol, UK.
Insights
This study analyzed primary surgical reconstructions for over 1500 children with cleft lip and/or palate in the UK. It details surgical techniques, timing, and adjuncts, providing a baseline for future effectiveness analysis.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Cleft lip and/or palate (CL±P) affects numerous children globally.
- Standardized data collection on primary surgical interventions is crucial for understanding treatment variations and outcomes.
- The Cleft Collective provides a valuable resource for longitudinal studies in the UK.
Purpose of the Study:
- To describe primary surgical reconstructions for children with CL±P in the UK.
- To document the timing, techniques, and adjuncts used in these primary surgeries.
- To establish a baseline for evaluating current cleft surgical protocols.
Main Methods:
- Retrospective analysis of surgical data from the Cleft Collective national longitudinal cohort study.
- Inclusion of 1782 surgical forms from 2015-2021, pertaining to 1514 children.
- Validation of demographic data through parental questionnaires.
Main Results:
- Median age for primary cheiloplasty was 4.3 months; anatomical subunit approximation was common for unilateral clefts.
- Soft palate reconstruction (median age 10.3 months) predominantly used intravelar veloplasty (94%).
- Hard palate reconstruction often involved vomer flaps (84%) with bimodal age distribution; varied antibiotic and steroid regimens were noted.
Conclusions:
- This study offers insights into current UK cleft surgical practices.
- It establishes a benchmark for future research on the efficacy of various surgical protocols.
- Understanding these pathways is essential for improving patient care and outcomes.
Objective:
This study describes primary surgical reconstructions performed for children born with a cleft lip and/or palate (CL ± P) in the United Kingdom (UK).
Design:
Data forms completed at the time of surgery included details on timing, technique, and adjuncts used during the operative period. Demographic data on participants were validated via parental questionnaires.
Setting:
Data were obtained from the Cleft Collective, a national longitudinal cohort study.
Patients:
Between 2015 and 2021, 1782 Cleft Collective surgical forms were included, relating to the primary reconstructions of 1514 individual children.
Results:
The median age at primary cheiloplasty was 4.3 months. Unilateral cleft lips (UCL) were reconstructed with an anatomical subunit approximation technique in 53%, whereas bilateral cleft lips (BCL) were reconstructed with a broader range of eponymous techniques. Clefts of the soft palate were reconstructed at a median age of 10.3 months with an intravelar veloplasty in 94% cases. Clefts of the hard palate were reconstructed with a vomer flap in 84% cases in a bimodal age distribution, relating to reconstruction carried out simultaneously with either lip or soft palate reconstruction. Antibiotics were used in 96% of cases, with an at-induction-only regimen used more commonly for cheiloplasties (P < .001) and a 5 to 7-day postoperative regime used more commonly for soft palatoplasties (P < .001). Perioperative steroids were used more commonly in palatoplasties than cheiloplasties (P < .001) but tranexamic acid use was equivalent (P = .73).
Conclusions:
This study contributes to our understanding of current cleft surgical pathways in the UK and will provide a baseline for analysis of the effectiveness of utilized protocols.
