Our Summary

This research is about a surgical procedure to correct cleft lip and palate, a birth defect where a baby’s lip or mouth does not form properly during pregnancy. In the United States, the standard approach is to do this in two separate operations: one for the lip and one for the palate.

However, some surgeons prefer to do it all in one operation. This is a bit controversial, as it’s not clear whether this approach is as safe or effective as the two-stage method.

The researchers wanted to compare the two methods. They looked at data from a large number of patients who had either the one-stage or the two-stage procedure. They were particularly interested in any complications that happened soon after the operation.

In total, they looked at data from 181 patients who had the one-stage procedure, and 1,790 who had the two-stage procedure. They found that there was no difference in the rate of early complications between the two groups.

However, they did find that patients with certain heart-related risk factors, or who had complications during the operation, tended to have a longer operation time.

The researchers concluded that the one-stage procedure does not appear to have a higher risk of early complications than the two-stage procedure. However, they noted that more research is needed to look at long-term outcomes, such as the shape of the face, rates of fistulas (abnormal connections between different parts of the body), speech, and dental outcomes.

FAQs

  1. What is the controversy surrounding single-stage primary cleft lip and palate (PCLP) repair in the United States?
  2. Were there any differences in early postoperative complications between single-stage PCLP repair and primary cleft lip (PCL) or primary cleft palate (PCP) repairs?
  3. What factors were found to significantly affect the operative time for patients within the PCLP group?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cleft lip repair is to follow postoperative care instructions carefully, including keeping the surgical area clean and avoiding activities that could put pressure on the healing incision. It is also important to attend follow-up appointments to monitor healing progress and address any concerns promptly. Additionally, maintaining good overall health and nutrition can help support the body’s healing process.

Suitable For

Patients with cleft lip and palate (CLP) are typically recommended cleft lip repair. This study found that single-stage primary cleft lip and palate repair is not associated with increased risk of early postoperative complications compared to primary cleft lip or palate repair alone. Patients with cardiac risk factors and those who experience complications during the surgery may have longer operative times. Long-term analyses of craniofacial morphology, fistulae rate, speech, and dental outcomes are important for a comprehensive assessment of the effects of combined cleft lip and palate repair.

Timeline

Before cleft lip repair:

  • Patient is diagnosed with cleft lip and palate
  • Patient undergoes preoperative evaluations and consultations with the surgical team
  • Surgery is scheduled and patient receives instructions for preparation

After cleft lip repair:

  • Patient undergoes the single-stage primary cleft lip and palate repair surgery
  • Patient is monitored closely in the immediate postoperative period for any complications
  • Patient is discharged from the hospital and instructed on postoperative care and follow-up appointments
  • Long-term follow-up is conducted to assess craniofacial morphology, fistulae rate, speech, and dental outcomes.

What to Ask Your Doctor

  1. What is the recommended timing for cleft lip repair in my case?

  2. What are the potential risks and complications associated with cleft lip repair surgery?

  3. How long is the recovery process expected to be after cleft lip repair surgery?

  4. Will additional surgeries or treatments be necessary in the future for optimal results?

  5. What can I expect in terms of scarring and appearance after cleft lip repair surgery?

  6. How experienced are you in performing cleft lip repair surgeries?

  7. What type of anesthesia will be used during the surgery and what are the potential risks associated with it?

  8. Will there be a need for post-operative care or follow-up appointments after the cleft lip repair surgery?

  9. Are there any specific dietary or lifestyle changes I should make before or after the surgery?

  10. Can you provide me with before and after photos of previous patients who have undergone cleft lip repair surgery?

Reference

Authors: Kantar RS, Rifkin WJ, Cammarata MJ, Maliha SG, Diaz-Siso JR, Farber SJ, Flores RL. Journal: J Craniofac Surg. 2019 Mar/Apr;30(2):384-389. doi: 10.1097/SCS.0000000000005039. PMID: 30531281