Optimal Timing of Cleft Lip Repair: Correlation With Scar Formation and Revision Rates

Area of Science:

• Plastic Surgery
• Pediatric Surgery
• Otolaryngology

Background:

• Hypertrophic scarring (HTS) and the need for revision surgery are common concerns following cleft lip repair (CLR).
• The optimal timing for primary CLR to minimize these outcomes remains debated.

Purpose of the Study:

• To investigate the association between earlier timing of primary CLR and the incidence of HTS and subsequent revision surgery.
• To evaluate the clinical implications of early cleft lip repair (ECLR) versus traditional cleft lip repair (TLR) on scar formation and reoperation rates.

Main Methods:

• A retrospective cohort study utilizing the TriNetX Analytics Network, a de-identified healthcare data network.
• Infants undergoing primary CLR before one year of age were classified into early (ECLR, <3 months) and traditional (TLR, 3-12 months) groups.
• Propensity score matching was employed to control for confounding variables, followed by statistical comparison of HTS and revision surgery rates.

Main Results:

• A total of 6786 infants were analyzed, with 4321 in the ECLR group and 2465 in the TLR group.
• The incidence of HTS was significantly lower in the ECLR group (3.2%) compared to the TLR group (5.2%, P=.002).
• Conversely, revision surgery was more frequent after ECLR (6.6%) than TLR (2.6%, P<.001), with these findings persisting post-matching.

Conclusions:

• Early cleft lip repair (<3 months) is associated with a reduced risk of hypertrophic scarring.
• However, earlier repair correlates with an increased requirement for subsequent revision surgery.
• These results highlight a critical trade-off in timing decisions for CLR, informing surgical planning and patient counseling.