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
Presenter: Irene Chang, BA
Steven Bernard MD
Director Name: Steven Bernard MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
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.
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.
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%).
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.
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