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Sequencing The Late Presenting Cleft Patient
Garland CB, Sivak WN, Bykowski MR, Camison L, Goldstein JA, Losee JE
University of Pittsburgh, Department of Plastic Surgery
2016-02-15
Presenter: Michael Bykowski
Affidavit:
The proposal was primarily the work of the submitting author.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Occasionally, patients with cleft lip and/or palate (CL/P) present late (>1 year) to the surgeon and require a departure from the typical treatment algorithm. Herein we present a review of our late-presenting cleft patients and an algorithmic approach.
Methods: All CL/P patients were retrospectively reviewed for those presenting after 1 year of age between 2002 and 2015.
Results: International adoption was the reason for late presentation in 7/8 patients (88%). Patients were divided into two groups as follows: UCLP (n=5), and BCLP (n = 3). Group 1 (UCLP) and Group 2 (BCLP) patients, respectively, presented at an average age of 15 months and 20 months and underwent the first procedure at 18 months (range 15-25 months) and 23 (range 16-33 months).
For Group 1, one patient underwent unilateral cleft lip repair only, as he had an intact palate. Three patients underwent palatoplasty or palatal adhesion with lip adhesion at the first stage, and formal lip and nose repair at the second stage. For Group 2, two patients underwent pre-maxillary setback and bilateral lip adhesion as their first stage, which was followed by palatoplasty and then lip repair.
Conclusions: Patients with CL/P may present late to cleft care due to international adoption or other medical comorbidities. UCLP patients do well with a 2-stage approach: lip adhesion at the time of palatoplasty, followed by formal cleft lip repair. BCLP patients often require a 3-stage approach: premaxillary setback at the time of lip adhesion, palate repair, and then lip repair.
