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Repair sequence and management of the premaxilla in patients with bilateral Cleft Lip and Palate: a systematic review of the literature
Irene A Chang BA, Bahar Bassiri Gharb MD PhD, Francis A Papay MD, Antonio Rampazzo MD PhD
Case Western University School of Medicine
2021-02-01
Presenter: Irene Chang, BA
Affidavit:
Steven Bernard MD
Director Name: Steven Bernard MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Bilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment sequence. A systematic review of the literature was performed to assess the current status of BCLP repair based on age.
Methods:
A PRISMA systematic review of the PubMed, Web of Science, and Embase databases was performed using a series of search terms related to BCLP. Studies were categorized based on the age of presentation, repair sequence, and technique.
Results:
The database search identified 381 articles. Of these, 72 manuscripts were ultimately included.
The lip was repaired first in 1,077 patients (86.0%), palate first in 161 patients (12.9%), and simultaneous lip and palate in 14 patients (1.1%). Patients less than 6 months old tended to receive lip repair first (n=959, 98.6%), with complications of unaesthetic appearance (n=86, 62.3%) and midface retrusion (n=41, 34.1%) in younger patients and wound dehiscence (n=8, 40%) in older patients. Primary lip repair was preceded by presurgical orthopedics (n=760) and/or lip adhesion (n=272) to reduce lip tension with nasoalveolar molding (n=452, 62.9%) or the Latham appliance (n=282, 37.1%). In older patients, the palate was repaired first or premaxillary setback (n=221) was indicated in protruded premaxillae greater than 10 mm, but carried the risk of premaxilla mobility (n=20, 37.7%) and midface retrusion (n=10, 18.9%).
Conclusion:
In younger patients, lip repair is performed first with preoperative orthopedics or lip adhesion, whereas in older patients, palate repair is first or premaxillary setback is indicated.
