Cleft Lip Surgery Research Articles

Primary Cleft Lip Repair in Adults Under Local Anesthesia.

There are many adults with cleft lip deformities in developing countries. This is due to the lack of public awareness, social stigma, distance from the health center, and parents' financial condition. Lip repair under local anesthesia is safe, cost-effective and would be beneficial for the underprivileged population. A retrospective cohort study with follow-up of 1 to 8 years. Academic Hospital. Cleft lip repair was performed in 252 patients of age more than 12 years from 2012 to 2019. Patients with cleft palate, cardiopulmonary disease, who did not consent for the procedure while awake were excluded. Cleft lip surgery done under local anesthesia. Outcome measures were patients' self-satisfaction and comments of peer. Two hundred fifty-two primary cleft lip operations were done in 168 male and 84 female patients. The mean age was 23.62 years, and the mean weight was 49.66 kg. Unilateral was 227, Bilateral cleft lip 25. The postoperative period was uneventful. No case of wound dehiscence or wound infection was observed. Patients were discharged on the same day, except the ones who traveled a long distance. Cleft lip repair in adults under local anesthesia is safe and cost-effective.

Thermographic analysis of postoperative changes in the nasal breathing efficiency in infants and young children with unilateral cleft lip.

Nowadays, cheilorhinoseptoplasty is one of the most efficient methods of cleft lip primary surgical treatment eliminating both functional and esthetic issues. In this work, we have proposed, developed, and experimentally tested a new thermography-based algorithm for studying the efficiency and symmetry of nasal breathing prior to and after the surgery. To investigate and analyze the external respiration function of an infant with unilateral cleft lip after surgical respiration symmetry restoration followed by anatomically shaped postoperative endonasal retainer installation, we have applied contactless thermal imaging in real time. The developed algorithm enables effective analysis of the respiratory function in infants before and after the surgery. Its combination with applied surgical technique experimentally demonstrated the potential of this approach for improving further the efficiency and symmetry of the airflows through the patient's nasal passages after the primary cheilorhinoseptoplasty. The results of our study constitute a novel and promising avenue of investigation into the breathing function in infants and young children prior to and after their surgery for unilateral cleft lip. The adaptation of our technique to the conditions of a pediatric hospital will make it a safe and informative tool for noninvasive diagnosing the respiratory function in infants in the early postoperative period.

Comprehensive Nursing Intervention Can Reduce Postoperative Complications and Shorten Hospital Stay of Children with Cleft Lip and Palate Repair Surgery

This research aims to probe into the impact of people-oriented comprehensive nursing intervention on children with cleft lip and palate repair surgery. Totally 112 lip cleft children who underwent surgical treatment in our hospital from June 2017 to March 2019 were randomized into routine and intervention groups. Among them, 55 in the former underwent routine nursing intervention, and 57 in the latter obtained comprehensive nursing intervention additionally. The hospital stay and complications of the two groups were observed. The hospital stay and complications in the latter were less than those in the former. Comprehensive nursing intervention can reduce postoperative complications and shorten hospital stay in children with cleft lip and palate repair surgery.

The role of scar massage in cleft lip surgery

Introduction: Despite advances in surgical technique for cleft lip, minimal evidence exists for methods of scar management, particularly scar massage. Some parents express concern that lip massage creates pain and distress to their children. This study aims to determine whether scar massage has enough cosmetic advantage to justify its use. Method: We reviewed 33 unilateral complete cleft lip repairs performed at our institution. Information on repair technique, suture material and scar management were recorded. Parent questionnaires and clinical photography were used with a panel of eight trained blinded observers asked to assess photos taken 24 months postoperatively. Scars were graded using a scale of 1 (very poor) to 5 (excellent). Twenty patients were included. Ethics approval was obtained from The Royal Children’s Hospital Melbourne Research Ethics and Governance office with HREC reference number QA/60562/RCHM-2019. Results: Frequency of scar massage was not associated with a better scar score (p= 0.36). Both the technique of repair and type of suture material used had greater effect on scar grading than massage therapy. Discussion: Problematic scarring following cleft lip surgery is a challenging outcome. This is the first study aiming to explore the effect of scar massage following cleft lip surgery. Conclusion: We found no conclusive evidence to support the use of scar massage in the postoperative care of cleft lip patients. Limitations include the retrospective nature of the study, low patient numbers and heterogeneity of surgical techniques. Nevertheless, there was no correlation seen between the frequency of massage and scar quality. Lip scar massage can cause significant pain to patients and distress to their family, warranting further studies to justify its use.

Hyaluronic acid concentration in the middle ear fluid as an indicator of severity of the secretory otitis in newborns with cleft palate.

The aim of the study was to investigate the hyaluronic acid concentration in middle ear fluid of patients with cleft palate as an indicator of the severity of the disease. Hyaluronic acid was examined in the middle ear fluid of 65 children (48 boys and 17 girls) subjected to cleft lip surgery in neonatal period up to 10 days of age. Patients were divided into 3 groups according to the course of the disease. First group consists of 15 patients with favorable course, second group consist of 25 patients with moderate course, third group included 25 patients with an adverse course. Hyaluronic acid levels were determined by commercially available immunoassay. The concentrations of hyaluronic acid in the middle ear fluid were as follows (mean+SEM): favorable course: 14253+2393 µg/l, moderate course: 7503+1345 µg/l, adverse course: 5905+2393 µg/l. Patients with adverse course and moderate course had significantly decreased hyaluronic acid levels in middle ear fluid compared to the patients with favorable course (P=0.02 and P=0.0018). Hyaluronic acid concentration is related to the course of the disease and the lowest values are most frequent in patients with an adverse course.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years.

SummaryBackground and trial designThe Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3).ObjectivesTo evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial.MethodsStudy models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds’ (5YO) index, and the GOSLON Yardstick. Student’s t-test, Pearson’s correlation, chi-square test, and kappa statistics were used in statistical analyses.ResultsThe reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment.ConclusionsThe results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable.Trial registrationISRCTN29932826.

Quality of Life in Patients With Velopharyngeal Insufficiency in West China.

This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. This is a cross-sectional study. The study was conducted in a tertiary medical center. The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann-Whitney U test was used to evaluate the patients' sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. In the univariate analysis, patients' age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.

Its Not about the Destination, Its about the Journey-Plotting 50 Years of Changing Clinical Trends in Plastic Surgery in a Public Sector Teaching Hospital.

Background The year 2019 marked the 50th anniversary of plastic surgery department of our institution. We present an audit to plot the changing clinical trends in our work in the past five decades. Methods A single-center retrospective cohort study based on the department demographics was performed and compared across the decades from 1969 to 2019. Results In 1969, the relative proportion of reconstructive versus cosmetic surgery procedures was 94.32% versus 5.68%; in 2019 this was 76.25% and 23.75%, respectively. An increase of 22 times increase in outpatient registrations, 13.1 times in total surgeries, 642 times in trauma reconstruction, 290 times for hand surgeries, and 323 times for skin tumor surgeries was noted. Male patients (64.9%) increased every decade more than females (35.1%), mostly for trauma surgery and gynecomastia correction. Proportion of pediatric cleft patients have markedly decreased. Spectrum of surgical procedures have widened. Top five reconstructive surgeries in 2019 were limb trauma reconstruction, skin tumor surgeries, hand surgeries, arterio-venous fistula (AV) creation, and oculoplasty. The most common surgery performed was cleft lip surgery in 1969 and hand surgery in 2019. The top five cosmetic surgeries performed in 2019 were scar revisions, nevus excision, liposuction and gynecomastia correction, rhinoplasty, and otoplasty. Conclusions Data collection and archiving and periodic audits help us study changing trends in our field compared with the global trends. Knowing societal demands will help to improve the resident training in teaching hospitals.

Update in Unilateral Cleft Lip Surgery.

After studying this article, the participant should be able to: 1. Describe the unilateral cleft lip and nasal deformity and associated anatomical variations. 2. Understand the history and evolution of the unilateral cleft lip repair. 3. List different presurgical treatment options. 4. Differentiate between surgical techniques. This article describes characteristics of the unilateral cleft lip and nasal deformity and its management, including presurgical orthopedics, operative techniques, and postsurgical care. The rotation-advancement and straight-line repairs are discussed in detail, as are the current concepts in primary cleft nose repair.

Botulinum Toxin for a Better Scar in Cleft Lip Surgery: A Prospective Randomized Control Trial.

An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair. The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements. Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A. Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.

Evaluation of Prognostic Factors for Palatal Fistulae after Cleft Lip and Palate Surgery in a North-Western Romanian Population over a 10-Year Period.

Cleft lip and palate is the most frequent birth anomaly, with increasing reported rates of complications, such as palate fistulae. Current studies concerning the occurrence rate of cleft lip and palate (CLP) report 2 to 10 cases in 10,000 births. The purpose of this study was to investigate the existence of factors that could predict the occurrence of fistulae after cleft lip and palate surgery. A retrospective study was performed by collecting and analyzing data from all patients who were operated for cleft lip and/or palate in the Maxillo-Facial Department of the Emergency Clinical County Hospital of Cluj-Napoca, Romania, between 2010 and 2020. We investigated the existing evidence for possible links between the number of fistulae observed after the primary palatoplasty and the age at which the primary palatoplasty was performed, the sex of the patient, the type of cleft, the timing of the surgical corrections, and the presence of comorbidities. A total of 137 cases were included for analysis. A significant link between the number of fistulae and the type of cleft was found (with fistulae occurring more frequently after the surgical correction of CLP—p < 0.001). No evidence was found for the existence of significant links between the number of fistulae and the patient’s sex, the timing of surgery, or the presence of comorbidities. This study concluded that the incidence of palatal fistulae appears to be influenced by the type of cleft (CLP), but not by the sex of the patient, the timing of surgery, or the presence of comorbidities.

Cleft Lip/Nasal Deformities After Plastic Surgery for Unilateral Cleft Lip/Palate: A Prospective Study at a Large Hospital in Vietnam.

IntroductionCongenital cleft lip, with or without cleft palate, is the most common deformity of the face. Primary plastic surgery for rehabilitation and esthetics is important for patients and their parents; however, secondary deformities of the lip and nose can occur after the primary surgery. Therefore, we performed assessment of secondary cleft lip/nasal deformities to aid in planning of surgical repair of these deformities.Materials and MethodsForty-six patients with unilateral cleft lip, with or without cleft palate, were operated with different techniques and examined post-surgery at the Department of Maxillofacial Surgery, University of Medicine and Pharmacy Hospital and Center of Odonto-Stomatology, Hue Central Hospital. They were assessed according to Motier’s post-operative evaluation scale (1997), including the red lip, white lip, scars, and nose.ResultsV notch and defect on the shift line were the most common deformities on the red lip (52.2%). About 34.8% of the patients had a short white lip on the cleft side. Straight and prominent scars were observed in 52.2% of the patients. The most common deformities of the nose were septal deviation (78.3%), followed by defects in the upper part of the nostril contour (78.3%), narrow sill (52.2%), and low position of the ala (47.8%).ConclusionSecondary cleft lip/nasal deformities are unavoidable. It is necessary to develop a plan for surgical repair of these deformities. There is no single method of cleft lip surgery that gives perfect results. Therefore, clinicians choose a combination of methods to bring optimal results for each patient.

Correction of lip and nasal deformities in bilateral cleft operated with Le Mesurier procedure

IntroductionBilateral cleft lip surgery recently evolved with the generalization of cheilorhinoplasty replacing cheiloplasty alone. The aim of this study was to analyze lip and nasal deformities of bilateral cleft lip operated on with the Le Mesurier procedure, and then to evaluate possible secondary surgical solutions used in our Cleft Center. Patients and methodsWe retrospectively reviewed a total of 39 patients born between 1991 and 2009 with a bilateral cleft all type included (isolated lip, lip and alveolar, associated or not with a cleft palate), all treated at the Caen University Hospital with a Le Mesurier procedure for the primary cleft lip closure. We studied population characteristics, the number of secondary surgical procedures for lip and nasal deformities. We analysed therapeutic approaches of the different secondary surgical procedures used and their morphological results. Results85% of patients needed at least one secondary surgical procedure, 28% two procedures, 15% three procedures and 8% four or more procedures. Median age at secondary surgery was 6,8. 79% had a “scar repositioning”, 33% managed the vermilion, 18% a restoration of the volume of the lip, 12% a philtral tissue sacrifice, 9% a procedure on Cupid's bow, 24% a surgery for nasal tip projection, 45% a columella lengthening and 58% a reposition of the alar base. DiscussionLe Mesurier procedure for bilateral clefts leads to deformities that require secondary surgical procedures. We propose an algorithm to manage loop scar in this procedure.

Morphological Correlations in Nasolabial Formation After Primary Lip Repair for Unilateral Cleft Lip

We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery. Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women's and Children's Hospital from 2017 to 2019. We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P=.012, r=0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistical significance (P=.00074, r=0.57); thus, the shorter the red lip, the higher was the oral commissure. The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid's bow, an unsettled major controversy in cleft lip surgery.

Efficiency of Post-Operative Pain Management in Infants undergoing Cleft Lip and Plate Repairs: A Study using the FLACC Scale

Background Post-operative pain relief in cleft surgery should be efficient and effective. The Face, Leg, Activity, Cry and Consolability (FLACC) scale is a validated tool for post-operative pain assessment in patients who cannot express themselves verbally. The objective of this study was to assess the effectiveness of the analgesic protocol practiced at the Dental Hospital Peradeniya, using FLACC scale during the first 24 hours following cleft surgery. Methods and material Sample included 193 patients who underwent primary repair of cleft lip and palate. They were given paracetamol two hours before surgery and 0.1mg/kg intravenous morphine during surgery. Infra-orbital nerve blocks for cleft lip surgeries, greater palatine nerve blocks for cleft palate surgeries and rectal diclofenac suppository (1.5 mg/kg) if above six months of age were added. The surgical site was infiltrated with 1% lignocaine in adrenaline. Oral paracetamol was used post-operatively. Cuddling, carrying, lullaby singing and nursing by mother was used as non-pharmacological strategies in the ward. Pain assessment was done at 5 min after recovery from anaesthesia and then at 30 minutes, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 5 hours and 6 hours after recovery, and then at 8 am and 12 noon on the day following surgery using the FLACC scale. Results The number of patients with severe to profound pain reduced gradually following recovery, except for a minor resurgence of pain at 2.5 hours. At the end of first 24 hours, 92.7% of patients had no pain according to the FLACC scale while only less than 1% had severe pain. Conclusion The combined protocol of pharmacological and non-pharmacological strategies used at the Cleft Centre was highly effective for relief of post-operative pain in cleft surgeries.

The Performance of Secondary Nasal Alar Base Revision for Unilateral Cleft Lip by Single YV-Plasty (the Importance of Overcorrection During Surgery).

Although primary surgery for cleft lip has improved over time, the degree of secondary cleft or nasal deformity reportedly varies from a minimum degree to a remarkable degree. Patients with cleft often worry about residual nose deformity, such as a displaced columella, a broad nasal floor, and a deviation of the alar base on the cleft side. Some of the factors that occur in association with secondary cleft or nasal deformity include a deviation of the anterior nasal spine, a deflected septum, a deficiency of the orbicularis muscle, and a lack of bone underlying the nose. Secondary cleft and nasal deformity can result from incomplete muscle repair at the primary cleft operation. Therefore, surgeons should manage patients individually and deal with various deformities by performing appropriate surgery on a case-by-case basis. In this report, we applied the simple method of single VY-plasty on the nasal floor to a patient with unilateral cleft to revise the alar base on the cleft side. We adopted this approach to achieve overcorrection on the cleft side during surgery, which helped maintain the appropriate position of the alar base and ultimately balanced the nose foramen at 13 months after the operation. It was also possible to complement the height of the nasal floor without a bone graft. We believe that this approach will prove useful for managing cases with a broad and low nasal floor, thereby enabling the reconstruction of a well-balanced nose.

Causes of delay in surgical repair of primary cleft lip and palate

Background: Cleft lip and palate are the most common congenital malformations of the head and neck. These disorders have high economic cost for families and impose a heavy psychological burden on children. Performing early primary reconstructive surgery on cleft lip and palate is necessary to achieve the desired treatment results. The aim of this study was to evaluate the etiology of primary cleft lip and palate reconstructive surgery retardation. Methods: In this descriptive study, 516 infants referred to Tabriz Children’s Hospital and Sina Hospital to do primary cleft lip and palate reconstructive surgery from 2009 to 2014, were studied. Ages at surgery, sex, comorbidities, cause of delay in referring the patients were evaluated. SPSS version 22 was used for statistical analysis. Results: The mean age of patients at surgery was 16.20 ± 25.97 months. There was a delayed referral for primary reconstructive surgery in 27.13% of the patients. The low weight of the child for surgery (30%), late visit of the child (19.28%), and lack of awareness among parents about the time of the visit (17.85%) were the most common causes of delay of reconstructive surgery. Conclusion: Based on the findings of this study, the low weight of the child for surgery, late visit of the child, lack of parents’ awareness about the time of the visit, comorbidities, late diagnosis, and low level of socio-economic, were the most common causes of delay in referring to reconstructive surgery respectively.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair.

BackgroundThe postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).MethodsNinety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.ResultsValues of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).ConclusionsThe conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds.

It is suggested that dental agenesis affects maxillary protrusion and dental arch relationship in children with unilateral cleft lip and palate (UCLP). In addition, an association between the need for orthognathic surgery and dental agenesis is reported. The aim was to study the impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8-year-old children with UCLP. The sample consisted of individuals with UCLP from Scandcleft randomized trials. The participants had available data from diagnosis of maxillary dental agenesis as well as cephalometric measurements (n = 399) and GOSLON assessment (n = 408) at 8 years of age. A statistically significant difference was found for ANB between individuals with agenesis of two or more maxillary teeth (mean 1.52°) in comparison with those with no or only one missing maxillary tooth (mean 3.30° and 2.70°, respectively). Mean NSL/NL was lower among individuals with agenesis of two or more maxillary teeth (mean 9.90°), in comparison with individuals with no or one missing maxillary tooth (mean 11.46° and 11.45°, respectively). The number of individuals with GOSLON score 4-5 was 47.2% in the group with two or more missing maxillary teeth and 26.1% respectively 26.3% in the groups with no or one missing maxillary tooth. No statistically significant difference was found in the comparison between individuals with no agenesis or with agenesis solely of the cleft-side lateral. Maxillary dental agenesis impacts on craniofacial growth as well as dental arch relationship and should be considered in orthodontic treatment planning.

Corelation Of Parents’ Profiles Of Children With Late Cleft Repair In Surabaya Cleft Lip And Palate Centre (January 2015 – December 2017)

Background : Optimal time of Cleft palate repair is during the 10 to 12 month of age. In this time produce far natural results in terms of speech because it enabled the maturation of scar tissue postoperatively. The soft palate must function properly before the patient starts learning to talk, otherwise speech disorders such as persistent rhinolalia aperta might arise. In pediatric patients, the role of parents is very important on adherence to therapy.Methods: This is a cross-sectional study. The first study group was parents of patients who had surgical repair before two years old and the second group was the parents of patients who had repair after two years old. We compared age, monthly income, education level, number of children, and residential distance from Surabaya of the two groups.Results : The data of this study were obtained from the medical records of patients with cleft lip surgery at CLP Center Surabaya in 2015th – 2017th with total of 358 patients, 172 were female and 186 were male. 52 patients with delayed cleft palate surgery. Patients’ parents in both groups were mostly 31-40 years old, were high school graduated, has one child, earned less than 1.5 million rupiah a month, and lived less than 100 kms from Surabaya. From the statistical results, parent’s income has the strongest correlation with the patient’s age in cleft palate surgery (-2.7). A negative coefficient means that the less parent’s income, the more patient likely had delayed cleft palate surgery. While other factors found weak and very weak correlations.Conclusions: The results form patient's parents' interview, concluded that besides economic factors, the lack of information cleft palate treatment is the key factors that contributed to the delay of cleft palate repair. The education level does not affect the delay in cleft palate surgery, because even in high educated parents, sometimes they don’t understand the stages of cleft lip and palate treatment. This study emphasized the necessity to educate about the stages of surgery by primary care physicians, to minimize delays.