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Unilateral Cleft lip and Palate: Long-Term Results of the Malek Technique
Anthony de Buys Roessingh1, Yohann Robert2, Josée Despars1
1Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
Insights
The Malek surgical procedure for unilateral cleft lip and palate (uCLP) in children shows a high fistula rate but yields good long-term speech outcomes. Further surgeries like Le Fort osteotomy and lip/nose revisions are common.
Area of Science:
- Craniofacial Surgery
- Pediatric Surgery
- Plastic Surgery
Background:
- Unilateral cleft lip and palate (uCLP) requires complex, multi-stage surgical management.
- Long-term outcomes of primary surgical techniques are crucial for patient quality of life.
Purpose of the Study:
- To evaluate the 18-year surgical and follow-up results of the Malek procedure for unilateral cleft lip and palate (uCLP).
Main Methods:
- Retrospective cohort study of children with uCLP operated between 1996-2001.
- Analysis included primary surgery, ENT interventions, maxillofacial surgery, and phonatory outcomes.
- Exclusion of syndromic cases.
Main Results:
- Sixty percent of patients developed fistulas; 88% required grommets.
- High rates of secondary procedures including alveolar grafting (97%), Le Fort osteotomy (22%), secondary lip surgery (29%), and rhinoplasty (29%).
- Despite complications, good long-term phonatory results were observed.
Conclusions:
- The Malek procedure for uCLP is associated with a significant risk of fistula.
- The technique provides favorable long-term phonatory outcomes.
- A substantial proportion of patients require subsequent surgical interventions.
Abstract:
To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek).
Abstract:
Retrospective cohort study.
Abstract:
Tertiary Children's Hospital.
Abstract:
All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded.
Abstract:
Results of the primary surgery, ear-nose-throat interventions, maxillo-facial surgery and final phonatory results.
Abstract:
Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13).
Abstract:
This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.
