Background This study reviews the 15 year program of our Department of Pediatric Surgery for the treatment and follow-up of children born with a cleft in Benin and Togo. Methods We analyzed files of children born in Africa with a cleft. They were referred to us through a nongovernmental organization (NGO) between 1993 and 2008 and assessed in Africa by local pediatricians before and after surgery. Operations were performed by our team. Results Two hundred files were reviewed: 60 cases of unilateral cleft lip, seven of bilateral cleft lip, 44 of unilateral cleft lip palate (UCLP), 29 of bilateral cleft lip palate (BCLP), 53 of cleft palate (CP), three of bilateral oro-ocular cleft, one of unilateral and two of median clefts (Binder), and one of commissural cleft. Sixty-nine (35 %) of these cases were not operated in Africa: 25 (12.5 %) had not shown up, 28 (15 %) were considered unfit for surgery (Down's syndrome, HIV-positive, malnutrition, cardiac malformation), and 16 (7.5 %) were transferred to Switzerland. Palatal fistula occurred in 20 % of UCLP, 30 % of BCLP, and 16 % of CP. Evaluation of speech after palate surgery gave less than 50 % of socially acceptable speech.Conclusions Our partnership with a NGO and a local team makes it possible to treat and subsequently follow children born with a cleft in West Africa. Surgery is performed under good conditions. If aesthetic results are a success, functional results after palate surgery need further improvement to promote integration in school and social life.

This study reviews the results after 18 years of our surgery and follow-up for children born in our hospital with a cleft palate (CP). Evaluation of 18-year-old youngsters born with CP, operated at the time by the same surgeon following the same primary surgical procedure (von Langenbeck). We analyzed the files of children born from 1997 to 2001 with a CP and operated in our hospital. Operations were performed by the same surgeon, following the von Langenbeck procedure adapted according to the children's age or weight. The evaluation was based on the results of the primary surgeries, final phonatory results, otorhinolaryngology interventions, maxillofacial surgery, and psychological needs. All syndromic children were excluded. Seventy-nine files from children born with a cleft were reviewed: 34 were taken into consideration and among them five Pierre Robin Sequence (PRS) were removed. Children were operated at a median age of 5,2 months (3-6). Eighteen percent had a fistula, 45% had grommets, 14% were operated for a pharyngeal flap following the Sanvenero-Rosselli technique to improve the phonatory score. Thirty-six (36) percent had a final phonation I, 32% a phonation I/II and 32% a phonation IIb. None had an osteotomy. All children were seen by our psychologist. A median of 5.5 multidisciplinary consultations were affected with a median number of general anesthesia of 2.4 (1-6).This retrospective study is based on one primary surgical technique used by the same surgeon. It shows that the von Langenbeck procedure done at six months entails a certain risk of fistula but shows good long-term phonatory results. The number of grommets used is low and must be seen in relation with otitis media and our follow-up. A few complements to our investigations and follow-up are proposed concerning grommets, surgical procedures, and sleep disorder.

To review at 18 years-old the results of surgery and follow-up of children born in our hospital with unilateral cleft lip and palate (uCLP). They were operated at the time by the same surgeon, following the same primary surgical procedure (Malek). Retrospective cohort study. Tertiary Children's Hospital. All children born with uCLP between 1996 and 2001 and operated in our hospital. Syndromic children were excluded. Results of the primary surgery, ear–nose–throat interventions, maxillo-facial surgery and final phonatory results. Seventy-nine files of children born with a cleft were reviewed: 34 were taken into consideration for uCLP: 15 right and 19 left. They were operated in two stages, following the inverse Malek procedure. Sixty per cent had a fistula. Eighty-eight percent had grommets. Ninety-seven percent had an alveolar graft at a median age of nine (5-10) and 22% underwent a Le Fort osteotomy. Seven percent were operated for a pharyngeal flap, 29% for a secondary lip surgery at a mean age of 12.8 and 29% for a late rhinoplasty at a mean age of 14.8 years. A median of 5.7 multidisciplinary consultations was realized with a median number of general anesthesia of 7.1 (4-13). This retrospective study shows that the Malek procedure for children born with uCLP is related to a high risk of fistula but good long-term phonatory results. Twenty percent of children were operated for a Le Fort procedure and one-third for a secondary lip procedure and rhinoplasty.