Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study
Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reporte...
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| Published in | International journal of surgery (London, England) Vol. 109; no. 6; pp. 1656 - 1667 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Lippincott Williams & Wilkins
01.06.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1743-9159 1743-9191 1743-9159 |
| DOI | 10.1097/JS9.0000000000000406 |
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| Abstract | Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.
A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.
A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.
Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care. |
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| AbstractList | Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.
A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.
A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.
Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care. Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature. Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.BACKGROUNDPatients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.PATIENTS AND METHODSA retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.RESULTSA total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.CONCLUSIONPatients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care. |
| Author | Chen, Yu-Ray Saito, Takafumi Pai, Betty C.-J. Hattori, Yoshitsugu Lo, Lun-Jou Lu, Ting-Chen Chou, Pang-Yun Chang, Chun-Shin |
| AuthorAffiliation | b Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan a Department of Plastic and Reconstructive Surgery and Craniofacial Research Center |
| AuthorAffiliation_xml | – name: a Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – name: b Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan |
| Author_xml | – sequence: 1 givenname: Yoshitsugu orcidid: 0000-0001-7946-9511 surname: Hattori fullname: Hattori, Yoshitsugu organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 2 givenname: Betty C.-J. surname: Pai fullname: Pai, Betty C.-J. organization: Department of Craniofacial Orthodontics and Craniofacial Research Center, Chang Gung Memorial Hospital, Kwei Shan, Taoyuan, Taiwan – sequence: 3 givenname: Takafumi surname: Saito fullname: Saito, Takafumi organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 4 givenname: Pang-Yun orcidid: 0000-0002-8390-7059 surname: Chou fullname: Chou, Pang-Yun organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 5 givenname: Ting-Chen surname: Lu fullname: Lu, Ting-Chen organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 6 givenname: Chun-Shin surname: Chang fullname: Chang, Chun-Shin organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 7 givenname: Yu-Ray surname: Chen fullname: Chen, Yu-Ray organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center – sequence: 8 givenname: Lun-Jou orcidid: 0000-0003-1606-7325 surname: Lo fullname: Lo, Lun-Jou organization: Department of Plastic and Reconstructive Surgery and Craniofacial Research Center |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37073546$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_bjps_2023_12_017 crossref_primary_10_1080_08869634_2024_2398739 crossref_primary_10_3390_jpm14090965 crossref_primary_10_3390_jcm13237334 crossref_primary_10_1097_GOX_0000000000006465 crossref_primary_10_1177_10556656241287079 crossref_primary_10_1097_JS9_0000000000001841 crossref_primary_10_1590_2177_6709_29_6_e2424151_oar crossref_primary_10_1177_10556656241298824 crossref_primary_10_1097_SCS_0000000000010467 crossref_primary_10_34921_amj_2023_4_021 crossref_primary_10_1080_27705781_2024_2367364 crossref_primary_10_1177_10556656241277395 crossref_primary_10_3390_diagnostics14222555 |
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| Title | Long-term treatment outcome of patients with complete bilateral cleft lip and palate: a retrospective cohort study |
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