Early one-stage repair of complete unilateral cleft lip and palate

J Craniofac Surg. 2009 Sep;20 Suppl 2:1723-8. doi: 10.1097/SCS.0b013e3181b3ef71.

Abstract

Background: The purpose of this prospective study was to evaluate craniofacial morphology in children with complete unilateral cleft lip and palate treated at the Brussels cleft center after a 1-stage complete closure at 3 months and compare the results with a series of children operated on at 3 and 6 months of age according to the Malek surgical protocol.

Methods: A series of 72 consecutive patients who were operated on for nonsyndromic complete unilateral cleft lip and palate were included in this study at approximately the age of 10 years. Thirty-four were treated according to the Malek surgical treatment protocol: the soft palate was closed at a mean (SD) age of 3.04 (0.20) months, followed by simultaneous repair of the lip and hard palate at 6.15 (0.67) months. Thirty-eight underwent 1-stage all-in-one (AIO) closure of the lip and hard and soft palates at 2.98 (0.16) months. Craniofacial morphology was evaluated by means of a digital cephalometric analysis. Cephalometric data were compared with a noncleft control group (n = 40) matched according to age. The same 2 series of children were followed up until 15 years of age, and the results were again compared.

Results: Statistical analysis (analysis of variance with post hoc Tukey test) showed in both groups who were operated on a decreased anteroposterior growth compared with the children without cleft at 10 years but the AIO group only was not different from the group without cleft. The maxillary (MxPI/SN) plane was significantly (P = 0.002) increased in the Malek cleft group compared with the AIO group with cleft. At 15 years of age, a difference was not observed anymore between the 2 groups for the anteroposterior growth or for the maxillary plane inclination.

Conclusions: One-stage AIO closure based on the Malek surgical principles provided good anteroposterior midfacial morphology and resulted in less opening of the maxillary plane to the anterior cranial base.

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Belgium
  • Cephalometry
  • Child
  • Child, Preschool
  • Cleft Lip / diagnostic imaging
  • Cleft Lip / surgery*
  • Cleft Palate / diagnostic imaging
  • Cleft Palate / surgery*
  • Female
  • Humans
  • Infant
  • Male
  • Maxillofacial Development
  • Prospective Studies
  • Radiography
  • Reconstructive Surgical Procedures / methods*
  • Treatment Outcome