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Single-Stage Primary Cleft Lip and Palate Repair

A Review of the Literature

Kantar, Rami S., MD; Rifkin, William J., BA; Cammarata, Michael J., BS; Maliha, Samantha G., BA; Diaz-Siso, J. Rodrigo, MD; Farber, Scott J., MD; Flores, Roberto L., MD

doi: 10.1097/SAP.0000000000001543
Review Paper

Background Single-stage cleft lip and palate repair is a debated surgical approach. While some studies have described favorable outcomes, concerns include the effect on craniomaxillofacial growth and increased risk of complications. To this date, there has not been a comprehensive appraisal of available data following combined cleft lip and palate repair.

Methods An extensive literature review was performed to identify all relevant articles. The level of evidence of these articles was graded according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence Scale.

Results A total of 22 relevant articles were identified, all of which were retrospective in nature. Patient age at the time of surgery ranged from 1 month to 10 years, the longest duration of follow-up was 18 years, and the largest study included 106 patients. Review of the literature shows that overall surgical outcomes following combined cleft lip and palate repair are encouraging. An increased rate of postoperative fistulas with associated speech abnormalities in some studies is noteworthy. Importantly, there is no evidence to suggest an impact on craniomaxillofacial growth, and psychosocial outcomes and parental satisfaction seem to be improved with single-stage surgery as compared with the staged approach.

Conclusions Our review shows overall favorable outcomes associated with combined cleft lip and palate repair. The limited follow-up time or nature of evaluated outcomes in some studies may underrepresent the true rate of adverse events, and highlights the need for additional long-term studies with standardized follow-up. To our knowledge, our review is the first to evaluate existing data regarding outcomes following combined cleft lip and palate repair.

From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.

Received February 19, 2018, and accepted for publication, after revision April 29, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Roberto L. Flores, MD, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 307 E 33rd St, New York City, NY 10016. E-mail:

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