Our Summary

This research paper is about a type of surgery used to repair cleft lip and palate in a single stage rather than multiple stages. Some studies have said this method is good, but others worry about problems it might cause, like affecting the growth of the face and skull or causing complications. To get a better understanding, the authors reviewed all the relevant research they could find.

They found 22 articles, all of which looked back at patients who had already had the surgery. These patients were anywhere from 1 month to 10 years old at the time of their surgery, and some were followed up with for as long as 18 years. The biggest study they looked at had 106 patients.

The authors found that the results of this single-stage surgery are generally good. In some studies, there was a higher rate of fistulas (abnormal connections between parts of the body) and speech problems after surgery. However, they didn’t find any evidence that the surgery impacts the growth of the face and skull. They also found that patients and their families seemed happier with the single-stage surgery compared to the multi-stage approach.

The authors conclude that this single-stage surgery has overall good results. But, some studies might not represent all the potential problems because they didn’t follow up with patients long enough or look at the right outcomes. They recommend more long-term studies with standardized follow-up to get a better idea of the real impact of this surgery. As far as they know, this is the first review of all the available data on this kind of surgery.

FAQs

  1. What is the debate surrounding single-stage cleft lip and palate repair?
  2. What are the potential risks or complications of combined cleft lip and palate repair?
  3. What are the findings on the impact of combined cleft lip and palate repair on craniomaxillofacial growth?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cleft lip repair is to ensure proper postoperative care, including keeping the surgical site clean and following any specific instructions provided by the surgeon. It is also important to attend follow-up appointments to monitor healing and address any potential complications. Additionally, the doctor may advise the patient on the importance of speech therapy and ongoing monitoring of speech development to address any potential speech abnormalities following the surgery.

Suitable For

Patients who are typically recommended for cleft lip repair are those with a cleft lip and/or palate deformity. These patients may range in age from 1 month to 10 years, and may have a variety of associated complications, such as speech abnormalities and fistulas. However, overall surgical outcomes following combined cleft lip and palate repair are encouraging, with no evidence to suggest an impact on craniomaxillofacial growth. Additionally, psychosocial outcomes and parental satisfaction seem to be improved with single-stage surgery as compared with the staged approach. Additional long-term studies with standardized follow-up are needed to further evaluate outcomes following combined cleft lip and palate repair.

Timeline

Before cleft lip repair:

  • Patient is born with a cleft lip deformity
  • Evaluation by a multidisciplinary team to determine the best treatment plan
  • Preoperative preparation including medical evaluations and counseling for the family
  • Surgical repair of the cleft lip typically performed when the patient is between 1 month to 10 years old

After cleft lip repair:

  • Immediate postoperative care including monitoring for complications such as bleeding or infection
  • Follow-up appointments to monitor healing and address any concerns
  • Long-term follow-up to assess outcomes such as speech development, facial growth, and psychosocial well-being
  • Overall, studies show favorable outcomes with combined cleft lip and palate repair, with no evidence of negative impact on craniomaxillofacial growth and improved psychosocial outcomes compared to staged approaches. Additional long-term studies are needed to further evaluate outcomes and potential complications.

What to Ask Your Doctor

  1. What is the recommended age for my child to undergo cleft lip repair surgery?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery process expected to be?
  4. Will my child require any additional surgeries in the future?
  5. How will the surgery affect my child’s speech development?
  6. What kind of long-term follow-up care will be necessary after the surgery?
  7. Are there any alternative treatment options available?
  8. How will the surgery impact my child’s facial growth and development?
  9. What is the success rate of combined cleft lip and palate repair surgery?
  10. How can I prepare my child for the surgery and post-operative care?

Reference

Authors: Kantar RS, Rifkin WJ, Cammarata MJ, Maliha SG, Diaz-Siso JR, Farber SJ, Flores RL. Journal: Ann Plast Surg. 2018 Nov;81(5):619-623. doi: 10.1097/SAP.0000000000001543. PMID: 29944528