The Efficacy of Perioperative Steroid Therapy in Pediatric Primary Palatoplasty

Abstract

Objective To determine if perioperative steroid therapy benefits pediatric primary palatoplasty patients. Design A prospective, double-blind, randomized trial with a placebo control. Setting An academic medical center. Patients Forty-five children undergoing primary repair of their cleft palate between 1989 and 1996 who were under the age of 48 months and without developmental delay or any associated syndrome. Interventions Intravenous dexamethasone sodium phosphate (0.25 mg/kg) or a placebo (5% dextrose in water) immediately preoperatively and once every 8 hours for two doses postoperatively. Main outcome measures Postoperative airway distress, fever, oral fluid intake, discharge eligibility, and palatal fistula formation. Results Perioperative steroid therapy significantly reduced the incidence of postoperative airway distress (p = .05) and postoperative fever (p = .02); postoperative oral fluid intake, discharge eligibility, and palatal fistula formation were not significantly affected. Conclusions Perioperative steroids effectively lower the risk of postoperative airway distress and postoperative fever in children undergoing the primary repair of their cleft palate. This finding favors a customary role for perioperative steroid therapy in pediatric primary palatoplasty.

The effect of steroid injection of the tongue base on reducing postoperative airway obstruction in cleft palate repair

“…Other studies revealed that peri-operative IV steroid effectively lowered the risk of postoperative airway distress and may play a role in reducing health care costs. 12,13 Despite the published data on the role of IV steroids in UAO after palatoplasty, there are no data on the role of steroids in reducing lingual oedema if injected locally in the tongue base prior to palatal repair. One case report described the great and prompt effect of steroid injected locally into the base of the tongue of a 20-year-old patient in reducing traumatic macroglossia after failure of other conventional measures.…”

Cleft Lip and Palate

“…Studies have found the incidence of airway obstruction to be up to 18% in nonsyndromic children with an isolated cleft palate 115,116 (Levels II and IV evidence). The risk increases even more when the cleft anomaly occurs as part of a syndrome.…”

“…Perioperative dexamethasone may decrease the risk of airway swelling and subsequent respiratory distress without detrimental effects on wound healing 115,116 (Levels II and IV evidence).…”

An Evidence-Based Approach to Cleft Palate Repair

“…3 Several retrospective analyses found the incidence of airway compromise in children with isolated cleft palate and no other medical problems to be up to 18 percent (Level II, IV Evidence). 4,5 This incidence, however, increases dramatically in children with syndromes; children with Pierre Robin sequence (micrognathia, glossoptosis, and airway compromise) and cleft palate are at particularly high risk for airway obstruction postoperatively (Level IV, V Evidence). 3,6 Other factors that may influence airway compromise are the presence of a smoker in the household and age less than 1 year at the time of surgery, although the latter variable is disputed in other studies (Level IV, V Evidence).…”

“…3,6 Other factors that may influence airway compromise are the presence of a smoker in the household and age less than 1 year at the time of surgery, although the latter variable is disputed in other studies (Level IV, V Evidence). 3,4 Comorbid medical conditions affect the outcomes of surgical procedures requiring general anesthesia. Therefore, preoperative evaluation by a pediatric genetic specialist can assist in stratifying the risk posed to a child by a general anesthetic and should be an integral part of preparing the family for palate repair.…”