Differences in Weight Loss and Recovery After Cleft Lip and Palate Repair

Kaye, Alison E.; Che, Columbine

doi:10.1177/1055665618774020

Cited by 13 publications

(10 citation statements)

References 12 publications

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“…No patients in this study suffered major complications, so a weight-based threshold to guide ECLR eligibility was unable to be established. Other studies have similarly reported that cleft lip repair, independent of timing, results in overall better weight gain and is not associated with a significant risk of surgical wound dehiscence and resultant postoperative feeding limitations (Kaye and Che, 2019; Matsunaka et al, 2019). Our findings align with the literature and provide evidence that ECLR improves postoperative weight gain and can eliminate the need for NAM in appropriate patients.…”

Section: Discussionmentioning

confidence: 93%

Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

Kondra

Stanton

Jimenez

et al. 2021

The Cleft Palate Craniofacial Journal

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Objective This study compares patients undergoing early cleft lip repair (ECLR) (<3-months) and traditional lip repair (TLR) (3-6 months) with/without nasoalveolar molding (NAM) to evaluate the effects of surgical timing on weight gain in hopes of guiding future treatment paradigms. Design Retrospective review. Setting Children's Hospital of Los Angeles, California. Patient, Participants A retrospective chart review evaluated patients who underwent ECLR or TLR ± NAM from November 2009 through January 2020. Interventions No intervention was performed. Main Outcome Measure(s) Patient demographics, birth and medical history, perioperative variables, and complications were collected. Infant weights and age-based percentiles were recorded at birth, surgery, 8-weeks, 6-months, 12-months, and 24-months postoperatively. The main outcomes were weight change and weight percentile amongst ECLR and TLR ± NAM groups. Results 107 patients met inclusion criteria: ECLR, n = 51 (47.6%); TLR + NAM, n = 35 (32.7%); and TLR-NAM, n = 21 (19.6%). ECLR patients had significantly greater changes in weight from surgery to 8-weeks and from surgery to 24-months postoperatively compared with both TLR ± NAM ( P < .05). Age-matched weights in the ECLR group were significantly greater than TLR ± NAM at multiple time points postoperatively ( P < .05). Conclusions ECLR significantly increased patient weights 24-months postoperatively when compared to TLR ± NAM. Specifically compared to TLR-NAM, ECLR weights were significantly greater at all time points past 6-months postoperatively. The results of this study demonstrate that ECLR can mitigate feeding difficulties and malnutrition traditionally seen in patients with cleft lip.

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Section: Discussionmentioning

confidence: 93%

Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

Kondra

Stanton

Jimenez

et al. 2021

The Cleft Palate Craniofacial Journal

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“…4,8,22 ONF formation is supposed to be a result of excessive tension at the suture lines, infection, compromised blood supply, poor tissue quality, lack of underlying bony support, external trauma and poor body condition. 8,9,14,16,21,23 In this case, as the overlapping flap was sufficient to cover the defect without tension and so the blood supply was not altered, involvement of the surgical technique seems unlikely. However, several factors may be contemplated, including skull growth with concurrent PBD widening, poor initial body condition or the potential presence of preoperative rhinitis (although not clinically observed).…”

Section: Discussionmentioning

confidence: 88%

“…However, there is no consensus, in animals and in children, on the optimal timing to perform primary repair of CCPs. 3,8,10–16 In dogs, some authors recommend performing the surgery at around 8 months of age. 8 However, performing a surgical repair either too early or too late (after 8 months) has been suggested to increase the risk of ONF formation.…”

Section: Discussionmentioning

confidence: 99%

Surgically treated congenital cleft palate in a 4-month-old kitten: medium-term clinical and CT assessment

Garnier

Viateau

Maurice

2022

Journal of Feline Medicine and Surgery Open Reports

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Case summary A 4-month-old female domestic shorthair kitten was presented for a congenital cleft palate causing nasal discharge and sneezing episodes. CT revealed a palatal bone defect involving 20% of the palatal area. Surgical correction of both the hard and soft palate defects was performed using the overlapping and medially positioned flap techniques, respectively. Complete healing of the wound and full resolution of the clinical signs occurred within a 1-month period. At 2 months postoperatively, two punctiform oronasal fistulae were observed rostrally without associated clinical signs. Control CT, performed 6 months postoperatively, revealed a 50% enlargement of the palatal bone defect. At 12 months postoperatively, the cat was still in good general condition without any clinical signs. Relevance and novel information To the best of our knowledge, this is the first report to describe the treatment of a congenital cleft palate in a kitten using the overlapping flap technique with a successful medium-term clinical outcome, despite the formation of two oronasal fistulae. This suggests that, as in dogs, full restoration of oronasal compartmentation is not mandatory to achieve functional outcome. The increase of the palatal bone defect over time may play a role in late oronasal fistulae formation and should be considered for surgical planning.

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“…Many of the included studies investigated the use of various analgesia techniques that aimed at reducing postoperative opioid consumption. 2,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Seven of the included studies investigated the effectiveness of bupivacaine for use in nerve block in cleft lip and/ or palate repair. 1,4,28,[30][31][32][33] All but 1 1 focused on infraorbital nerve block placement in cleft lip surgery patients.…”

Section: Pain and Analgesiamentioning

confidence: 99%

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

Grue

McGuire

Hong

et al. 2022

Journal of Craniofacial Surgery

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Background: Cleft lip and/or palate repair techniques require continued reevaluation of best practice through high-quality evidence. The objective of this systematic review was to highlight the existing evidence for patient safety and quality improvement (QI) initiatives in cleft lip and palate surgery. Methods: A systematic review of published literature evaluating patient safety and QI in patients with cleft lip and/or palate was conducted from database inception to June 9, 2022, using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using Methodological Index for Non-Randomized Studies, Cochrane, or a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 instruments, according to study type. Results: Sixty-one studies met inclusion criteria, with most published between 2010 and 2020 (63.9%). Randomized controlled trials represented the most common study design (37.7%). Half of all included studies were related to the topic of pain and analgesia, with many supporting the use of infraorbital nerve block using 0.25% bupivacaine. The second most common intervention examined was use of perioperative antibiotics in reducing fistula and infection (11.5%). Other studies examined optimal age and closure material for cleft lip repair, early recovery after surgery protocols, interventions to reduce blood loss, and safety of outpatient surgery. Conclusions: Patient safety and QI studies in cleft surgery were of moderate quality overall and covered a wide range of interventions. To further enhance PS in cleft repair, more highquality research in the areas of perioperative pharmaceutical usage, appropriate wound closure materials, and optimal surgical timing are needed.

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Differences in Weight Loss and Recovery After Cleft Lip and Palate Repair

Cited by 13 publications

References 12 publications

Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain

Surgically treated congenital cleft palate in a 4-month-old kitten: medium-term clinical and CT assessment

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

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