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Lessons Learned from a Single Institution's Eight Years of Experience with Early Cleft Lip Repair
Idean Roohani1,2, Collean Trotter1,2, Pasha Shakoori3
1Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Insights
Early cleft lip repair (ECLR) offers a safe and effective alternative to traditional nasoalveolar molding (NAM) and later surgery for infants with cleft lip and palate. This approach improves lip and nasal symmetry without significant complications.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Reconstructive Surgery
Background:
- Traditional management of wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) followed by surgical repair at 3-6 months.
- An early cleft lip repair (ECLR) protocol, performing surgery at 2-5 weeks without NAM, has been implemented.
- This study evaluates the institutional ECLR protocol over eight years for 188 patients with cleft lip and/or palate (CL/P).
Purpose of the Study:
- To present the institution's early cleft lip repair (ECLR) protocol for unilateral or bilateral CL/P deformities.
- To assess the safety, efficacy, and outcomes of ECLR compared to traditional methods.
- To evaluate the impact of ECLR on the need for nasoalveolar molding (NAM).
Main Methods:
- Retrospective review of 188 patients (ASA class I or II) undergoing ECLR (2015-2022).
- Analysis of anthropometric data and pre/postoperative photographs for nasal and lip symmetry.
- Evaluation of operative times, anesthetic times, and complication rates.
Main Results:
- Average age at ECLR was 1.0 ± 0.5 months.
- Low complication rate (2.1%) and manageable lip revision rates (11.4% unilateral, 15.4% bilateral).
- Significant improvements in nasal and lip symmetry (p < 0.001) were observed postoperatively.
Conclusions:
- ECLR is a safe and effective protocol for correcting unilateral and bilateral cleft lip and nasal deformities in eligible infants.
- ECLR significantly reduces the need for NAM, reserving it for specific complex cases.
- This approach offers a valuable alternative, improving outcomes and reducing the burden of care for CL/P patients.
Abstract:
Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution's ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL/P deformity. Materials and Methods: Retrospective review was conducted at Children's Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015-2022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 ± 0.5 months. Mean operative and anesthetic times were 120.3 ± 33.0 min and 189.4 ± 35.4, respectively. Only 2.1% (4/188) of patients had postoperative complications. Lip revision rates were 11.4% (20/175) and 15.4% (2/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p < 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.
