1. Percentage of Patients Returning for
Cleft Palate Repair Following Cleft Lip Repair
Nicholas Sinclair1, Michael Capata1, Bjorn Schonmeyr MD2, Lisa Wendby2,
Alexander Campbell MD2, Donald Laub MD3.
University of Vermont College of Medicine1, Operation Smile India2, Department of Plastic Surgery – Fletcher Allen Health Care3
Results
Abstract
The overall return rate for all patients was 24.9% (n=179/718).
Stratified results are shown in Figure 1.
This is a retrospective study that set out to calculate rate at which patients returned for primary cleft palate repair after primary cleft lip repair. Using the medical record database at the Guwahati Comprehensive Cleft Care Center, this return rate was calculated for three age groups (<6 years; 6 – 18 years; >18 years). We found that three quarters of patients with both cleft lip and cleft palate do not return for cleft palate repair.
Figure 1. Cleft Palate Return Rates Stratified by Age
Summary and Conclusions
Three quarters (75.1%) of CLP patients did not return to have their palate repaired after lip repair. This number may be skewed by adult patients in whom palate repair is not considered essential. However, two thirds (69.9%) of CLP patients under 6 years of age, those patients who could benefit most from palate repair, did not return to have this second surgery.
The result of this large series provides evidence that patients do not return for cleft palate repair after repair of their lip. This is prompting consideration to repair the palate first in this population of patients from Northeast India.
Background
Top: Operating Theater at the Guwahati Comprehensive Cleft Care Center
Left: Patient Walking to the Operating Theater
Right: Post-Operative Care in the Recovery Room
In developed countries, cleft lip repair is performed between three months and six months of age, followed by cleft palate repair around the age of one. However, in the developing world, cleft patients present at later ages, changing the time frame of these surgeries. Due to speech outcomes, palate repair is a more time sensitive procedure than lip repair, ideally performed before the second year of life. Multiple cleft care authorities have questioned the staging of lip repair before palate repair when working in developing nations. One concern is that patients may not return for cleft palate surgery after the cleft lip has been repaired.
This study was designed to determine what percentage of patients with a cleft lip and palate (CLP) at a high volume center in Assam, India return for cleft palate repair after having their lip repaired.
Methods
The study identified CLP patients who had received primary cleft lip repair at the Guwahati Comprehensive Cleft Care Center in Assam, India between January 2011 and December 2012 (n=718). In all patients, primary cleft lip repair had been performed before cleft palate repair. Using December 2012 as the cutoff for primary cleft lip repair, all patients were at least 6 months post-operative. This ensured that all patients had adequate time to heal and were eligible for subsequent cleft palate repair. An overall return rate for palate repair was calculated.
Patients were also stratified by age group (<6 years; 6 – 18 years; >18 years) and the return rate for each group was determined.
Authors
Acknowledgements