Efficacy and Safety in Combining Primary Palatoplasty and Myringotomy in Patients with Cleft Palate

Abstract

Background: Patients born with a cleft lip and palate undergo multiple surgical procedures, increasing the infants’ exposure to anesthesia and potential risk of neurocognitive delays. In addition, these numerous procedures lead to greater use of hospital resources. This study analyzes the differences in anesthetic exposure and perioperative characteristics between performing combined versus separate primary palatoplasty (PP) and placement of bilateral myringotomy tubes (BMT). Methods: We reviewed patients younger than 2 years who underwent PP and BMT at our institution from June 2014 to January 2019. Patients who underwent PP and BMT during the same admission (combined group = 74) and during separate admissions (separate group = 26) were studied. Due to the small sample size in the separate group, additional data for this group were gathered by propensity score matching by gender, race, and American Society of Anesthesiology class. Statistical analyses were carried out to identify significant differences between the 2 groups. Linear regression was performed to compare perioperative variables. Results: One hundred patients met the inclusion criteria. There were no significant differences in demographic characteristics or American Society of Anesthesiology class, surgery and anesthesia duration, dosage of intraoperative dexmedetomidine, hospital length of stay, and perioperative complications ( P > 0.05). Per contra, combined group had significantly lower intraoperative dosages of fentanyl ( P = 0.01) and shorter postoperative care unit stay ( P = 0.047). Conclusions: This study documents decreased postoperative care unit time and anesthesia drug exposure without increased length of stay or perioperative complications in patients undergoing combined PP and BMT. These results support combining PP and BMT to reduce exposure to potentially neurotoxic medications and to increase efficient utilization of hospital resources.

The Effect of Intervelar Veloplasty Under Magnification (Sommerlad’s Technique) Without Tympanostomy on Middle Ear Effusion in Cleft Palate Patients

“…The conclusion mentioned above could be wrong since cleft palate affects speech development and patients with the more severe form of deformity logistically need more surgery. Therefore, the lower speech-related abilities were attributed to the more disease severity [19]. Likewise, Balraj et al suggested that combining procedures may be more costeffective and decrease the total burden on families [20].…”

Impact of COVID-19 on Cleft Surgical Care

“…Most cleft care centers, including our own, frequently combine cleft surgical procedures with ear tube placement to eliminate the risks and burdens associated with undergoing multiple anesthetics. 20 Likewise, many craniofacial surgeons combine ONF repairs and ABG procedures for the same reasons. 21 Similar rates when comparing the pre-pandemic to the COVID-19 cohorts highlights the efforts of our cleft team to continue to provide the highest level of care despite the challenges posed during the COVID-19 pandemic.…”

Role of myringotomy in patient with cleft palate

“…type of study Park MS et al, 8 retrospective Sumun K et al, 9 retrospective Jung SE et al, 10 retrospective Mantilla-Rivas et al, 11 retrospective Shaffer AD et al, 12 retrospective Yang CH et al, 13 retrospective Bruneel L et al, 14 retrospective Imbery TE et al, 15 retrospective Kim E et al, 16 retrospective Ha S et al, 17 retrospective Annigeri VM et al, 18 retopective Kobayashi H et al, 5 retopective 16 , as they reported that after adjustment for potential confounders with multivariate analysis, patients who received four or more sets of VTs, those with a history of TM perforation, and those with isolated cleft palate were found to be at an increased risk for hearing loss at 10-year follow-up. Age of first tube placement and total number of otologic complications were not independent predictors of hearing loss on adjusted analysis.…”