Cleft Palate Surgery Research Articles

Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost and Efficiency.

To assess surgical instrument usage in cleft lip (CL) and cleft palate (CP) surgery and create an optimized surgical tray with an associated cost-savings analysis. Prospective, observational study. Single institution, 6-month prospective review. A total of 10 primary CL surgeries and 10 primary CP surgeries were included in this study. Complete lists of surgical instruments utilized in CL and CP surgeries were collected. The average instrument UFs were 26.0% for CL and 22.6% for CP. The estimated costs were $33.15 to $290.29 for the original CL surgical tray and $10.20 to $63.80 for the optimized tray. For CP, the original tray's cost was estimated at $38.25 to $319.00, and the optimized tray at $9.18 to $57.42. This demonstrates a cost reduction of $22.95 to $226.49 for CL and $29.07 to 261.58 for CP. The idealized surgical instrument tray could contribute to reducing healthcare expenditures and promoting operating room efficiency, patient safety, and environmentally friendlier operating theaters.

Robert H. Ivy: The First Professor of Plastic Surgery and Cleft Palate Surgery Pioneer

Robert H. Ivy: The First Professor of Plastic Surgery and Cleft Palate Surgery Pioneer

Considering the Environmental Impact of Cleft Lip and Palate Surgery.

We sought to calculate the waste generated by cleft lip and palate (CL/P) procedures and to increase awareness of the environmental impact of our speciality. Waste from 5 CL/P procedures was categorised into 5 streams and weighed. A carbon calculator tool was used to convert weight of waste in to estimated carbon emission over a 12-month period. The study was carried out in a university teaching hospital. This was an assessment of the waste produced from 5 paediatric CL/P procedures. Weight of waste produced as result of CL/P procedures, measured in kilograms (kg); weight of CO2, measured in kg. We found that 768.5 kg of surgical waste was generated by CL/P procedures at our centre annually. This equates to 2653 kg of CO2. This study serves as a reminder of surgeons' responsibility to oversee how the waste we produce is disposed of.

Comparison of palatal fistula incidence post palatoplasty with Veau-wardill kilner technique between men and women

Cleft palate is a congenital abnormality that occurs in the mouth and surrounding structures. The most used classification of cleft palate by Veau (1931). To repair the palatal defect, shape and function, surgical correction is necessary. There are various types of palatoplasty techniques that can be used, such as Veau-Wardill-Kilner. Palatoplasty may causes complications such as palatal fistula. Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Airlangga University has been carrying out a social service for cleft lip and palate surgery repair since year 2008 in various regions in Indonesia. However, until now, there is no data available related with the incidence of palatal fistula. Purpose: To observe the comparison between the palatal fistula incidence post palatoplasty using Veau-Wardill-Kilner technique based on gender. Methods: This study based on 113 palatoplasty cases using Veau-Wardill-Kilner technique taken from Oral and Maxillofacial Cleft Palate Surgery Social Service data, Faculty of Dental Medicine, Airlangga University from the period of 2013 until 2022. Data analysis used Kruskal-Wallis on IBM SPSS version 29 Windows. Results: from 113 patients, 20 cases (17,7%) showed that there is developed palatal fistula. Between the incidence of palatal fistula in men and women observed after palatoplasty procedure using Veau-Wardill-Kilner, higher percentages of palatal fistula were found in women (p=0.426). Conclusion: The incidence of palatal fistula post palatoplasty using Veau-Wardill-Kilner technique in women is higher than men.

Impact of Geopolitical Unrest on Surgical Delays and Outcomes in Immigrant Populations With Cleft Lip and Palate

Background: Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development. Methods: This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed. Results: Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status (P=0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months. Conclusions: This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Predictor Variables of Intraoperative Blood Loss during Cleft Palate Surgery

Study design: Cross-sectional study Objectives: To determine the predictor variables associated with blood loss during cleft palate surgery. Method: This was carried out for 12 months. Pre-operative records of each participant were taken including the age, sex, BMI, haematocrit, haemoglobin concentration, the length of the cleft defect and the width. Blood loss was determined using colorimetric method of measurement. The blood loss was calculated using the appropriate formula. Multiple regression analysis was done to determine the predictors of increased blood loss. Statistical analysis was carried out with IBM SPSS version 23.0 (2015) with statistical significance assessed at a p-value of ≤ 0.05, and a 95% confidence interval. Result: A total of 39 participants were recruited for this study, with a median age of 24 (IQR: 21–48) months. The mean length of the defects was 32.1±2.6 mm while the mean duration of surgery was 118.1±38.1 mm. The median value of the intra-operative blood loss was 40.2(IQR: 26.7–60.5). The duration of surgery and the age of the patient were the only statistically significant variables in regression analysis (p<0.0001). Conclusion: Predictor variables of increased intra-operative blood loss were the duration of surgery and the age of the patient.

Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery.

To consider the clinical anatomy, safety and effectiveness of the suprazygomatic maxillary nerve block in cleft palate surgery. Observational case series. Single cleft centre in the United Kingdom. Patients born with a cleft palate (with or without a cleft lip) undergoing palatal surgery between the ages of 9 months and 18 years. Introduction of suprazygomatic maxillary nerve (SZMN) block using ropivacaine 0.2% into clinical protocol in February 2023. Peri-procedure complications and post-operative opioid administration. The clinical anatomy of the SZMN block is described in a stepwise and pictorial approach from superficial to deep structures. 43 patients underwent surgical interventions involving the palate (either intravelar veloplasty, Furlow palatoplasty or bilateral myomucosal buccinator flaps for palatal lengthening). 22 patients had a general anaesthetic and local anaesthetic infiltration and 21 had an additional SZMN block. There were no local or systemic complications associated with the SZMN block. There was no difference in the total dosing of post-operative (P = .79) opioids between the groups. We demonstrate the feasibility and safety of this procedure without the use of ultrasound guidance in a heterogenous group of paediatric patients undergoing palatal surgery. Regional anaesthesia should be considered as part of the multi-modal analgesic strategy, although it may be difficult to demonstrate a change in opioid use in clinical settings where enhanced recovery techniques are established, and opioid use is already low.

Patient Screening and Selection for Cleft Lip and Palate Surgery Procedures

Patient Screening and Selection for Cleft Lip and Palate Surgery Procedures

Cleft lip and palate surgery in the Otolaryngology and Head-neck surgery department of a Medical College Hospital in Bangladesh

Background: Cleft lip and palate (CLP) are one of the most common developmental anomalies in orofacial region. CLP surgery lies in the anatomical domain of Ear Nose Throat and Head - Neck Surgery. In Bangladesh specialty of plastic surgery is still in developing stage and plastic surgeons are not easily available everywhere. ENT and Head-Neck surgeon had to take up the responsibility of some of cleft patients. This article is a retrospective analysis of a series of 200 cases of cheiloplasty and palatoplasty done in ENT and Head-Neck Surgery department of Khulna City Medical College Hospital, Bangladesh. Results were satisfactory in our, patient and parent's consideration. Objective: Our aim is to discuss the demographic profile, presentations, degree & type of cleft and outcome of CLP surgery in Otolaryngology and Head-Neck Surgery department of a Medical College Hospital of Bangladesh. We will also discuss the embryology of face & historical background of the cleft surgery. Materials and Methods: This is a retrospective analysis of CLP surgery for 200 cleft patients. We based on inclusion and exclusion criteria for selection of patients. Majority of cleft lip patients were operated following the Millard modified rotation advancement technique and isolated cleft palate patients were operated following Von Langenbeck bipedicle flap and Veau-Wardil-Kilner V-Y pushback technique in the ENT and Head-Neck Surgery Department of a Medical College Hospital. Patients were advised for periodic follow up. Results: Total of 200 patients of CLP were operated in our department out of which male was 92 (46%) and female was108 (54%)), male and female ratio being 1:1.08. The age range was 3 months to 40 years with a mean of 8.38 years. Pre alveolar group both male and female comprised of 134 (67%) and alveolar group 66 (33%) patients and that of isolated cleft palate 7 (10.60%) patients. Pre alveolar unilateral CLP was high. The results of surgery were satisfactory in our postoperative evaluation. Patients and parents were also satisfied with the outcome. Conclusion: Majority of CLP patients don’t suffer functional problem apart from facial disfigurement. Restoration of normal anatomy, facial appearance and function can be achieved by surgery in appropriate time and age. Few cases may be associated with feeding difficulties, dental and hearing problems. Some cases are associated with other congenital anomalies and syndromes. Those cases demand team approach of different specialty.

Development and Characterization of a Novel Composite Hydrogel Biomaterial for Improved Mucoperiosteal WoundRepair.

Mucoperiosteal wound healing, as it occurs after pediatric cleft palate surgery, can be challenging due to the limitations of current treatments such as tissue flaps secured with sutures and fibrin glue. In this study, we characterized the in vitro performance of a novel composite hydrogel biomaterial designed to be employed as an in situ wound filler and enhance mucoperiosteal wound healing. We evaluated a range of photopolymerizable formulations containing methacrylated gelatin (GelMA), glycol chitosan, and bioglass microparticles. Our aim was to identify one or more formulations with an appropriate balance of properties against a set of functional requirements that we established for this application. To test the formulations against these criteria, we measured photopolymerization kinetics, mechanical properties, degradation rate, in vitro biocompatibility, and ex vivo tissue adhesion. All formulations polymerized in less than 90 s using violet light. In addition, we found that GelMA-based hydrogels were more adhesive to mucoperiosteal tissue than clinical standard fibrin glue. Inclusion of small amounts of bioglass in the formulation increased mechanical compatibility with mucoperiosteal tissue, enhanced cytoconductivity, and promoted cell proliferation. Taken together, our results support the suitability of these photopolymerized composite hydrogels as in situ mucoperiosteal wound fillers. Overall, this study lays the groundwork for investigating the in vivo, pre-clinical effectiveness of these composite hydrogels in improving mucoperiosteal wound healing outcomes.

A Comprehensive Review of Nasoalveolar Molding: From Origins to Future Advances

Globally, the most prevalent birth malformations is cleft palate and cleft lip, etiology of cleft is multifactorial and occurrence is as a result of inaccurate tissue fusion. The treatment objective in these patients include restoration of normal anatomy to obtain desired skeletal, cartilaginous and soft tissue relationship. To minimize the severity of cleft before surgery of cleft lip and palate, a nonsurgical methods such as Nasoalveolar molding (NAM) can be used to reshape and align the lip, nostrils, and gingiva. There are various techniques available for Nasoalveolar molding which will be summarized in this article.

Causative agent for perioperative anaphylaxis in a child with autism successfully identified using the intradermal test under general anesthesia

BackgroundThe skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia.Case presentationAn 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful.ConclusionsConcerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis.

Efficacy of Tranexamic Acid in Reducing Blood Loss in Cleft Palate Surgeries - A Systematic Review

Efficacy of Tranexamic Acid in Reducing Blood Loss in Cleft Palate Surgeries - A Systematic Review

Dexmedetomidine as a total intravenous anesthetic in pediatric patients undergoing cleft lip and palate surgery: a case series

BackgroundSurgery for pediatric cleft lip and palate repair often utilizes high-dose opioids and inhaled anesthesia, thereby causing postoperative complications such as desaturation and/or severe agitation after anesthesia. These complications are detrimental to the child and medical personnel and cause tremendous psychologic stress to parents. Our aim is to decrease these complications through dexmedetomidine, an alpha-2 receptor agonist with anxiolytic, sympatholytic, and analgetic properties. Devoid of respiratory depressant effect, it allows patients to maintain effective ventilation and reduce agitation, postoperatively. Its unique anesthetic property may shed light on providing safe anesthesia and gentle emergence to this young, vulnerable population.Case presentationA total of 21 patients of Sundanese ethnicity, aged 3 months to 8 years (9 males and 12 females), underwent cleft lip or cleft palate surgery using total intravenous dexmedetomidine. Anesthesia was induced using sevoflurane, fentanyl, and propofol, and airway was secured. Intravenous dexmedetomidine 1.5 μg/kg was administered within 10 minutes, and a maintenance dose of 1.5 μg/kg/hour was continued as the sole anesthetic maintenance agent thereafter. Hemodynamics and anesthetic depth using Patient State Index (SEDLine™ monitor, Masimo Corporation, Irvine, CA, USA) were monitored carefully throughout the surgical procedure. Dexmedetomidine did not cause any hemodynamic derangements or postoperative complications in any of our patients. We found agitation in 9.5% (2/21) of patients.ConclusionDexmedetomidine can be used as a total intravenous anesthetic agent to maintain anesthesia and provide gentle emergence to infants and young children undergoing cleft lip and palate repair.

A single-center prospective study of perioperative anesthetic complications in cleft lip, alveolus, and palate surgeries in a teaching hospital in Lagos, Nigeria

ABSTRACT Background: Cleft lip and/or palate are one of the most common congenital craniofacial anomalies that require surgical management. Patients undergoing primary cleft repair are at increased risk of perioperative anesthetic complications due to their young age and anatomical defects. Aim: This study aimed to present the frequency of perioperative airway-related morbidities in the anesthetic management of cleft lip, alveolus, and palate surgeries. Patients and Methods: This study was conducted at Lagos University Teaching Hospital, Nigeria. Patients undergoing cleft lip, alveolus, or palate repair were prospectively studied from January 2015 to December 2019. Data on patient demography, type of cleft, presence of syndromes and other deformities, and intra- and postoperative complications were collected. Results: A total of 150 patients were included, with a median age of 15.5 months, and 67 (44.7%) of the patients were <12 months old. Most patients were female (56%), and the most common type of cleft was lip, alveolus, and palate (36.6%). Sixteen (10.7%) of the patients had associated syndromes. Notably, intraoperative complications were observed in 5 (3.3%) patients, including laryngospasm and difficult intubation. Postoperative complications were rare, with one case of nasal bleeding. Significant associations between presence of other deformities and syndromes and intraoperative complications were noted (P < 0.05). Conclusion: Patients with orofacial clefts and other deformities tend to be predisposed to anesthetic complications. However, the incidence of anesthetic complications in this study was low (3.3%) probably because the current protocol used in the author’s hospital for cleft surgeries was followed and appropriate.

A Systematic Review of Perioperative Nerve Blocks for Cleft Lip and Palate Surgeries

A Systematic Review of Perioperative Nerve Blocks for Cleft Lip and Palate Surgeries

Clinical Evaluation of 51 Patients with Cleft Lip and/or Palate in Social Work at Syariah Hospital.

The study aims to evaluate the surgical outcomes, including post-operative complications, in patients undergoing cleft lip and palate surgery in social work. The study was conducted on 51 patients in three social work settings, with inclusion criteria of age over 3 months, weight over 10 pounds, and normal chest x-ray results. Patients with syndromic or cardiac abnormalities were excluded from the study. The surgery was performed by a team of oral and maxillofacial surgeons with a minimum of 2 years of surgical experience. The study found that post-operative complications were relatively rare and could be managed well. This study has important implications for improving the quality of healthcare services for patients with cleft lip and palate, as well as increasing public awareness of the importance of proper medical care for this condition.

The Maxillary Nerve Block in Cleft Palate Care: A Review of the Literature and Expert's Opinion on the Preferred Technique of Administration.

Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors. First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients. Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA's run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant. Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.

Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya.

Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya. A retrospective chart review was performed on all patients who received CLP repair at Kapsowar Hospital between 2011 and 2023. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. For the most recent year of study (2023), the authors performed a financial audit of all costs related to the performance of unilateral cleft lip surgery. Descriptive statistics were performed. The authors identified 381 CLP surgeries performed on 311 patients (197 male, 63.3%). The most common etiology of the cleft was left unilateral (28.3%). The average age of primary lip repair decreased from 46.3 months in 2008 to 2009 to 20.2 months in 2022 to 2023 ( P <0.001). The average age of primary cleft palate repair decreased from 38.0 months in 2008 to 2009 to 25.3 months in 2022 to 2023 ( P <0.001). Patients traveled from 23 districts to receive treatment. Age of treatment was not different when distinguished by sex, county poverty level, or travel time from the hospital. The total costs associated with cleft lip repair was $201.6. Adequately staffed hospitals in rural locations can meaningfully address a regional CLP backlog more cost-effectively than surgical mission trips.

Analysis and Reporting of Randomized Trials in Cleft Palate Surgery: Learning from the Timing of Primary Surgery (TOPS) Trial.

The Timing of Primary Surgery (TOPS) trial was published August 2023 in the New England Journal of Medicine and is a milestone achievement for a study focused on cleft palate. Due to the complexity of outcome reporting in cleft and the rarity of such comparative trials, TOPS presents a useful opportunity to critically review the design, analysis and reporting strategies utilised. This perspective article focused on the inclusion of participants, the choice of the primary outcome measure and the analysis of ordinal data within the trial. Considerations for future comparative studies in cleft care are discussed.