Combined early cleft lip and palate repair in children under 10 months – a series of 106 patients

Abstract

This article reviews a series of 106 patients presenting with cleft lip and palate who underwent a simultaneous combined cleft lip and palate repair under the age of 10 months. The technique is described together with the early postoperative results. A single surgeon (the author) operated on the 106 patients. The youngest patient was 6 weeks old, and the smallest weighed 2.3 kg. All patients underwent palate repair, followed by lip repair, at a single sitting. The palate repair used the Sommerlad technique with radical muscle repositioning and bilateral lateral Langenbeck-type releasing incisions when indicated. Of the total, 71 patients (67%) had a unilateral lip and palate cleft and underwent a modified Millard repair; 34 (32%) had a bilateral lip defect and underwent a modified Mulliken repair; and one (1%) had a midline cleft lip. Ten patients were excluded from the study, as their palate was deemed too wide to close. Instead, they underwent cleft lip repair and vomer flap to the anterior palate alone. The mean duration of the procedure was 97 min. There was neither mortality, nor significant anaesthetic complications. Two patients who had low oxygen saturation postoperatively were taken back to the theatre. In both cases, the soft palate sutures were removed and the airway improved to a safe degree, permitting return to the ward for subsequent final repair. All patients were discharged home without any ongoing problems. One patient subsequently developed a unilateral dehiscence of a bilateral lip, and seven patients underwent a second procedure to close a palatal fistula. Early follow-up results are encouraging, with only 8% of patients to date requiring a second procedure. Although technically challenging, cleft lip and palate repair in a single simultaneous procedure is a successful and, most importantly, a safe procedure, which enables the complete clefting condition to be repaired early and in a single operation.