A Modified Surgical Schedule for Primary Management of Cleft Lip and Palate in Developing Countries

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Introduction:In developing countries cleft lip and palate (CLP) patients arrive late, and there is a risk of drop out for functionally important palatoplasty after lip repair. Patients may be underweight, anemic, and prone to recurrent infections.Objective:To repair cleft palate at an appropriate time and secondly to avoid the drop out after the first surgery.Protocol:A new surgical protocol has been designed for patients with CLP in whom the cleft palate is first repaired at 6 to 9 months of age or whenever the patient presents at the clinic. The cleft lip is repaired 3 to 6 months after the first surgery.Patients and Results:When cleft lip repair was performed before palate repair (conventional protocol group) in 89 patients with CLP, the median interval between first and second surgery was 290 days. However, when the modified protocol was followed in 330 patients over 13 years, the median interval was 193 days (p < .0002). The reduction in the interval is statistically significant. In eight patients cleft palate fistula encountered after palatoplasty was repaired during cleft lip repair thus avoiding a third surgery.Conclusions:The compliance for two surgeries in CLP has improved. Apart from achieving the main aim of the new protocol, a number of advantages were noticed. The palate repair was easier in the presence of an unrepaired cleft lip. The anterior palate repair was more dependable with reduced incidence of anterior palatal or alveolar fistula.

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