Cleft lip management protocol at the Royal Jordanian Rehabilitation Center : four years retrospective analysis

الملخص EN

Objective : Cleft lip is a common congenital anomaly in our population.

It imposes serious psychological and social disturbances in both children and their families.

Centralization of cleft lip care led to the great evolution of pre surgical orthodontist management and the continuous rejuvenation in surgical techniques, hence primary cleft lip repair with primary rhinoplasty has become the keystone of successful management.

In this study we present our experience and current practice at the Royal Jordanian Rehabilitation center which were based on successful centralization of cleft lip care with strict commitment to rules of modern cleft multidisciplinary care.

Methods : This is a retrospective study of 100 patients with cleft lip/palate who were classified and surgically treated in our cleft unit from January of 2014 to January of 2018.

Pre surgical orthopedics (nasoalveolar molding– NAM- and taping) were applied in 98% of the cases.

Surgical technique included both Chang Gung cleft lip nasal repair (variant of rotation advancement techniques) and the Anatomic subunit approximation repair (variant of geometric repairs).

Both Tajima semi open rhinoplasty and McComb techniques were utilized in primary nasal repair.

All surgeries were performed under general endotracheal anesthesia on inpatient basis.

All minor revisions for secondary deformities were performed on outpatient basis.

Average follow up period is 2 years.

Results : The geographic distribution of deformity was highest in the north of Jordan followed by the middle and south (48 % : 44 % : 8 % respectively).

The age of the patients at the time of operation ranged between 3 And 6 months (mean age was 3.5 months).

Male to female ratio was 72%:28%, ratio of cleft lip : cleft lip / palate (CL : CLP) was 52 % : 48 %, ratio of unilateral to bilateral deformity was 80 % : 20 %, ratio of complete to incomplete deformity was 56%:44%.

In unilateral cases ratio of left to right deformity was 65 % : 35 %.

The average weight at time of surgery was 5.1 Kg.

The most common associated congenital deformity was congenital heart disease (most common was atrial septal defects) in 25 % of cases.

Associated craniofacial deformities Included : hypertelorism in two cases, binder syndrome in two cases, Van der Woude syndrome in one case, type 4 craniofacial cleft in one case and microtia in one case.

8 % of cases had positive family history of cleft.

Mean operative time was 120 minutes and mean hospitalization period was 36 hours.

Morbidity consisted of 3 cases with stich sinuses and minor dehiscence and two cases of pneumonia.

There was no mortality.

The most common secondary deformities were vertical nostril collapse in 23 % of the patients, hypertrophic scarring in 10 % of the patients, excess vermillion deformity in 5 %, wide prolabium in 2% and vermilion border mismatch in 2 %.

Conclusion : Centralization of cleft lip care with multidisciplinary and inter disciplinary decisions between cleft team members led to the dramatic improvement in total care.

Achieving near normalcy in the shape and function of the cleft patients is the definitive goal with decreasing the number and complexity of subsequent procedures.