Cleft lip, alveolus and palate: Defect or dislocation malformation? Importance of adopting a physiological concept for surgical repair in achieving optimal outcomes in LMICs. Part 2: Integration of physiological growth considerations into a surgical concept

Objective: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. Design: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Setting: Tertiary neonatal and pediatric surgery center. Patients: Hospital A: 61 newborns, Hospital B: 157 newborns. Interventions: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Main Outcome Measures: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Results: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. Conclusions: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

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Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC)

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620947604 ◽

2020 ◽

Vol 57 (11) ◽

pp. 1314-1319

Author(s):

Luc Malemo Kalisya ◽

Jacques Fadhili Bake ◽

Bake Elisee ◽

Kavira Nyavandu ◽

Robert Perry ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Democratic Republic ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Democratic Republic Of Congo ◽

Orofacial Clefts ◽

Republic Of Congo ◽

General Surgeons ◽

North Kivu

Background: There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. Methods: This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. Results: A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. Conclusions: Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.

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Rhinoplasty in the Cleft Lip Patient

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0063_ritclp_2.3.co_2 ◽

1997 ◽

Vol 34 (1) ◽

pp. 63-68 ◽

Cited By ~ 2

Author(s):

Gilbert J. Nolst Trenité ◽

Richard H.L. Paping ◽

Albert H. Trenning

Keyword(s):

Cleft Lip ◽

Surgical Repair ◽

Operative Procedure ◽

Scar Tissue ◽

Graft Material ◽

Nasal Vestibule ◽

Secondary Rhinoplasty ◽

Custom Made ◽

Postoperative Problems ◽

Cleft Lip Nose

Several important factors to consider in the surgical repair of the cleft lip nose are described: the importance of an adequate lip closure technique to ensure symmetry can prevent a more conspicuous deformity of the nose during growth, the consequences of secondary rhinoplasty in the growing nose in which the surgeon has to weigh the possible growth inhibition due to scar tissue against the possible functional and esthetic improvement, a systematic surgical approach in which the operative procedure is divided Into different steps, and the use of autogenous graft material. In the evaluation of 52 cleft lip patients (5 bilateral clefts, 47 complete unilateral clefts) who had undergone a secondary rhinoplasty, two specific postoperative problems were encountered: slight to moderate recurrence of the caudal septal deviation (in unilateral clefts) and restenosis of the nasal vestibule at the cleft side. Adjustment of the surgical technique and the use of a custom-made vestibulum device diminished these sequellae considerably.

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Comparison of professional and laypeople evaluation of nasolabial esthetics following unilateral cleft lip repair

European Journal of Dentistry ◽

10.4103/ejd.ejd_31_18 ◽

2018 ◽

Vol 12 (04) ◽

pp. 516-522 ◽

Cited By ~ 1

Author(s):

Adekunle Moses Adetayo ◽

Modupe Olusola Adetayo ◽

Oguntade Funmi A ◽

Mayowa Solomon Somoye ◽

Michael O Adeyemi ◽

...

Keyword(s):

Prospective Study ◽

Cleft Lip ◽

Surgical Repair ◽

University Teaching ◽

Facial Esthetics ◽

Surgical Evaluation ◽

Significant Disagreement ◽

Cleft Lip Repair ◽

Unilateral Cleft Lip Repair ◽

A Prospective Study

ABSTRACT Objectives: The objective is to know the extent of agreement of clinicians' perception of nasolabial esthetic compared to that of laypeople (parents). Materials and Methods: This was a prospective study of comparison of clinician's perception of nasolabial esthetics with that of laypeople following surgical repair of UCL. Participants were recruited from the Cleft Clinic of the Lagos University Teaching Hospital, and surgical repair of the cleft was performed under general anesthesia. Surgical evaluation was done through direct clinical evaluation using the modified form of the Christofides' criteria by laypeople and professionals. Results: A total of 48 cleft participants were enrolled in the study. The evaluation of the lip by both the laypeople and professionals was similar, and there was no difference (0.588) in their rating. However, there was a significant disagreement (P = 0.001) between them in the nose assessment. Conclusion: Neither the solitary opinion of the professionals nor that of the laypeople is satisfactory in the evaluation of facial esthetics; both are equally important, especially in the assessment of nasal esthetics. However, opinion of either the laypeople or the professional might be enough in the evaluation of the lip esthetics.

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