Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study

Abstract

Background Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. Objective To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. Methods A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student’s t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. Results There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5–65) months and 8 (IQR: 5.5–16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard’s rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59–193.70, P-value = 0.005). Conclusion There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher’s method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

Age at primary surgery among orofacial cleft individuals in Indonesia

“…Figure 4 compares the proportion of delayed primary cleft surgeries among countries based on previous studies. 6,7,18 Regarding delayed primary lip surgery beyond 6 months of age, this study revealed the highest contribution to surgical delay (65.3%). In terms of delayed primary palatal repair beyond 18 months of age, the results from Indonesia (67%) were comparable to those of the Nigerian study (67.1%).…”

“…Previous studies within the 5 years time-frame have explored the STX database to gain insight of OFC in multiple LMIC settings, 13,[23][24][25][26] or single LMIC settings such as Nigeria. 6 These studies have demonstrated the significant role of a humanitarian organization in enhancing access to care for those in need while also increasing research volume for treatment outcome and epidemiology fields. Indonesian population that would otherwise be challenging to study.…”

“…Whereas secondary surgeries were defined as the subsequent surgeries performed after the primary surgery on the same anatomical region of the cleft. 6 Primary cleft lip surgery is crucial for restoring the normal anatomy and function of the lip, correcting nasal deformity and reconstructing the floor of the nose to achieve proper alignment of the gum line, whereas primary cleft palate surgery is essential to close the palatal defect and establishing a properly functioning velopharyngeal mechanism to facilitate normal speech production. 7,8 Delay in reconstructive cleft lip surgery leads to detrimental effects on physical appearance, speech development, feeding, dental and psychological conditions.…”

Management in Cleft Lip and Palate Surgery : A Systematic Review

“…This rec ommendation is based on the findings of our research. Abd El-Ghafour, 2020 14 16 Nigeria retrospective cohort study…”

“…The intraoperative and early postoperative complications associated with cleft lip and palate were assessed. 15 Michael, et al (2023) 16 conduected a study with 314 cleft surgery. The mean age of the patients was 58.08 ± 99.65 months.…”