Our Summary

This research paper is about a condition known as midface hypoplasia (MFH), which involves the underdevelopment of the middle part of the face. This condition often occurs after the repair of a cleft lip and palate, but the exact reasons why it happens are not well understood. The researchers analyzed data from 24 different studies that involved a total of 326 patients.

They found that patients who only had their cleft lip repaired (and not their palate) were more likely to develop MFH, particularly if they also had a cleft palate to begin with. However, this was not the case for patients who had both their cleft lip and palate repaired - their facial development was similar to people without clefts.

This suggests that the scarring from lip repair surgery alone is not the main cause of MFH. However, the researchers note that the studies they analyzed did not provide enough detail on factors such as the timing of the surgery, the techniques used, follow-up time and the severity of the cleft.

So, in simpler words, this paper says that the repair of a cleft lip alone in patients who also have cleft palate may lead to underdevelopment in the middle part of the face. However, more research is needed to fully understand why this happens.

FAQs

  1. What is midface hypoplasia (MFH) and how is it related to cleft lip repair?
  2. Why does MFH not occur in patients who have both their cleft lip and palate repaired?
  3. What additional factors would need to be studied to better understand the cause of MFH after cleft lip repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cleft lip repair is to ensure that they undergo comprehensive treatment that includes repair of both the cleft lip and palate, if applicable. This can help reduce the risk of developing midface hypoplasia and promote more balanced facial development. Additionally, it is important for patients to follow up with their healthcare provider regularly and discuss any concerns or potential complications that may arise post-surgery.

Suitable For

Typically, patients who are recommended for cleft lip repair are those who are born with a cleft lip, which is a common birth defect that occurs when the lip does not form properly during fetal development. Cleft lip repair is usually recommended within the first few months of life to improve the child’s ability to eat, breathe, speak, and hear.

In some cases, patients may also have a cleft palate, which is a similar birth defect that affects the roof of the mouth. In these cases, patients may require surgery to repair both the cleft lip and palate.

It is important for patients with cleft lip to be evaluated by a team of specialists, including surgeons, speech therapists, orthodontists, and psychologists, to determine the best treatment plan for their individual needs. Early intervention and proper surgical repair can help improve the patient’s quality of life and overall facial appearance.

Timeline

  • Before cleft lip repair: The patient is born with a cleft lip, which is a gap or split in the upper lip. This can cause feeding difficulties, speech problems, and aesthetic concerns.

  • Cleft lip repair surgery: Typically performed when the patient is a few months old, the surgery involves closing the gap in the lip, reshaping the nose if needed, and creating a more normal appearance.

  • After cleft lip repair: The patient will need follow-up appointments to monitor healing and ensure proper growth and development. Speech therapy may be needed to address any speech issues.

  • Development of midface hypoplasia: In some cases, patients who have had cleft lip repair surgery may develop midface hypoplasia, which involves underdevelopment of the middle part of the face. This can affect facial symmetry and overall appearance.

  • Further treatment: If midface hypoplasia occurs, further treatment may be needed, such as orthodontic treatment, maxillofacial surgery, or craniofacial surgery to correct the facial underdevelopment.

Overall, the timeline for a patient before and after cleft lip repair involves initial diagnosis, surgery to repair the cleft lip, follow-up care, and potential treatment for any complications such as midface hypoplasia. It is important for patients to receive comprehensive care from a multidisciplinary team to address all aspects of their condition.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cleft lip repair include:

  1. What are the potential long-term effects of cleft lip repair surgery on the development of my facial structure?
  2. Are there any specific factors that may increase my risk of developing midface hypoplasia after cleft lip repair?
  3. What are the different surgical techniques used for cleft lip repair, and how do they impact the risk of midface hypoplasia?
  4. How soon after birth should cleft lip repair surgery be performed, and does the timing of the surgery affect the risk of developing midface hypoplasia?
  5. What follow-up care is necessary after cleft lip repair surgery to monitor for any signs of midface hypoplasia?
  6. Are there any additional treatments or interventions that can help prevent or address midface hypoplasia in patients who have undergone cleft lip repair?
  7. Can you provide more information about the potential impact of cleft palate repair on the development of midface hypoplasia?

Reference

Authors: Celie KB, Wlodarczyk J, Naidu P, Tapia MF, Nagengast E, Yao C, Magee W 3rd. Journal: Cleft Palate Craniofac J. 2024 Jan;61(1):20-32. doi: 10.1177/10556656221116005. Epub 2022 Jul 25. PMID: 35876322