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Outcomes of Cleft Lip Repair for Internationally Adopted Children

Mulliken, John B. M.D.; Zhu, Deanna R.; Sullivan, Stephen R. M.D., M.P.H.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 1439–1447
doi: 10.1097/PRS.0000000000001162
Pediatric/Craniofacial: Original Articles

Background: Large numbers of international children with cleft lip–cleft palate are adopted in the United States; many underwent their first operation before arrival.

Methods: The authors reviewed records of internationally adopted children with cleft lip–cleft palate treated by one surgeon over 25 years. This study focused on anatomical types, frequency/methods of repair, correction of unrepaired deformities, and secondary procedures in this country.

Results: Of 105 internationally adopted children with cleft lip–cleft palate, 91 percent were Asian; 75 percent had labial or labiopalatal closure in their native country. Of repaired unilateral cleft lips, 43 percent required complete revision, 49 percent required minor revisions, and 8 percent required no revision. All repaired bilateral cleft lips were revised; 90 percent were complete and 10 percent were minor. “Delayed” primary nasal correction was always necessary in both unilateral and bilateral forms. Labial closure was scheduled first in young infants with an unrepaired unilateral defect, whereas palatal closure took precedence in older children. Premaxillary setback and palatoplasty were scheduled first in older children with unrepaired bilateral cleft lip–cleft palate. Of children arriving with repaired palate, 43 percent required a pharyngeal flap.

Conclusions: Whenever cleft lip–cleft palate is repaired in another country, revision rates are high for both unilateral and bilateral types. Nevertheless, primary closure in the native country may increase the likelihood for adoption. Traditional surgical protocols often are altered for an adoptee with an unrepaired cleft lip–cleft palate, particularly the sequence of labial and palatal closure, depending on the child's age and type of defect.

Boston, Mass.; and Providence, R.I.

From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School; the Division of Plastic and Reconstructive Surgery and the Department of Pediatrics, Warren Alpert Medical School of Brown University; and the Department of Plastic Surgery, Rhode Island Hospital and Hasbro Children’s Hospital.

Received for publication July 28, 2014; accepted November 3, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

John B. Mulliken, M.D., Department of Plastic and Oral Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Mass 02115,

©2015American Society of Plastic Surgeons