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Analysis of Complications in Primary Cleft Lips and Palates Surgery

Zhang, Zhaoqiang DDS*; Fang, Silian DDS, PhD*; Zhang, Qingbin DDS, PhD; Chen, Lei MD, PhD; Liu, Yarui MD§; Li, Kefeng PhD; Zhao, Yan MD

Journal of Craniofacial Surgery: May 2014 - Volume 25 - Issue 3 - p 968–971
doi: 10.1097/SCS.0000000000000832
Clinical Studies
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Introduction A series of retrospectively recorded patients with cleft lip and palate was uniquely investigated to demonstrate and analyze the complications after cleft repairing operations in a selected Chinese population.

Material and Methods From January 2005 to January 2012, a selected group of 2100 patients with cleft lip and/or palate who have complete records were chosen from a large sample in the units. Complete data were retrieved, including sex, age, clinical classification, surgical modality, complications, and follow-up results. The complications were classified into 2 categories: early and long-term complications. After surgery, most patients with cleft lip remained in the hospital for 7 days and cleft palate repairs for 10 days. A standard regimen of antibiotics was administered for 3 to 5 days clinically.

Results Of the 2100 patients, there were 1360 males and 760 females who had congenital cleft deformity with complete clinical records in the department of oral and maxillofacial surgery. The age distribution was as follows: 1600 patients in the group of 3 months to 2 years, 320 patients in the group of 2 to 10 years, 130 patients in the group of 11 to 19 years, and 50 patients in the group of older than 20 years. As to the treatment modality, cleft lips were repaired by rotation advancement method with various minor modifications or Tennison modality. The cleft palates were closed using the von Langenbeck, Veau/Wardill/Kilner, or Furlow technique. The overall complication rate was 16.8% of the patients. Of the early complications, there were 6 cases of asphyxia, 17 cases of pyrexia, 5 cases of edema of the respiratory tract, 8 cases of upper respiratory tract infection, 6 cases of bronchiolitis, 7 cases of pneumonia, 9 cases of diarrhea and vomiting, 6 cases of hemorrhage, 5 patients of odontoptosis, 11 cases of erosion of the corner of mouth, 5 cases of drowsiness, 11 cases of incision dehiscence, 9 cases of wound infection, 6 cases of palatal dehiscence/fistula, 3 cases of nostril floor breakdown, 7 cases of conjunctivitis, as well as 3 cases of mortality. The long-term complications included 30 cases of secondary lip/nasal deformity, 10 cases of dehiscence of lip, 14 cases of palatal fistula/decencies, 18 cases of hearing problem/otitis media, 21 cases of poor ventilation/snoring, 66 cases of velopharyngeal incompetence, and 58 cases of voice disorder.

Conclusions Complications after cleft surgery are unavoidable clinically. More attention should be paid to the etiologic factors to minimize the prevalence of complications. Mortality can be found in patients with cleft, which is a deadly complication. Problems of respiratory tract and hemorrhage should be emphasized and treated seriously.

From the *Department of Stomatology, The Sixth Affiliated Hospital of Sun Yat-Sen University; †Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guangzhou Medical University; ‡Department of Burns Surgery, the First Affiliated Hospital, Sun Yat-sen University; §Department of Pediatric Dentistry, School and Hospital of Stomatology, Guangzhou Medical University, Guangzhou, Guangdong, China; ∥Department of Medicine, School of Medicine, University of California, San Diego, California; and ¶Department of Head and Neck Surgery, The Fourth General Hospital, Hebei Medical University, Shijiazhuang City, Hebei Province, China.

Received April 8, 2013.

Accepted for publication January 31, 2014.

Address correspondence and reprint requests to Qingbin Zhang, DDS, PhD, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guangzhou Medical University, 39 Huangsha Rd, Liwan District, Guangzhou City, Guangdong Province, 510140, China; E-mail: qingbinandzhaoqiang@hotmail.com

The authors report no conflicts of interest.

Authors Zhang and Fang contributed equally to the article.

© 2014 by Mutaz B. Habal, MD.