The purpose of the study was to see the short-term outcome of simultaneous repair of cleft lip and cleft hard palate with vomer flap against cleft lip repair alone in patients with unilateral complete cleft lip and palate (UCLP). A prospective observational study was carried out in 35 patients with unilateral complete cleft lip and palate who under-went cleft lip and cleft hard palate repair with vomer flaps simultaneously. After 3 months, cleft soft palate was repaired. During 1st and 2nd operations, the gap between cleft alveolus and posterior border of the cleft hard palate was measured. Postoperative complications, requirement of blood transfusion during the operation, and duration of operations were also recorded. Simultaneous repairs of cleft lip and closure of cleft hard palate with vomer flaps are easy to perform and are very effective for the repair of cleft lip and palate in UCLP patients. No blood transfusion was needed. Gaps of alveolar cleft and at the posterior border of hard palate were reduced remarkably, which made the closure of the soft palate easier, decreased operation time, and also decreased the chance of oronasal fistula formation. 1. Introduction Every year more than 5000 patients with cleft lip and palate are born [1]. The incidence of cleft lip and/or cleft palate in Bangladesh is 3.9 per 1000 live births [2]. Patient with cleft lip-palate usually leads a very miserable life unless surgically treated, due to the ack of social support, inadequate multidisciplinary approach to deal with the total problems, and most of the cleft patients come to the doctor only when their parents are aware or when the child had some problems like repeated respiratory tract infection, feeding difficulty, and social problems (e.g., even maternal divorce) [1]. For those reasons, we get patients of varying ages and problems like repeated ear infection, abnormal teeth eruption, permanent articular problems, and deafness. Some parents prefer cleft lip repair first irrespective of the age of the child only for aesthetic region and do not come again for cleft palate or oronasal fistula closure due to poverty, transport problem, and lack of knowledge [1, 3]. There are many procedures for the closure of the cleft lip and palate [4–7]. In unilateral complete cleft lip-palate (UCLP), if only cleft lip repaired first, it needs extensive dissection during palatoplasty, taking more time for operation and more chances of oronasal fistula formation, and if cleft palate repair is done earlier, there may be midfacial growth disturbance [8, 9]. But, after
References
[1]
K. M. N. Ferdous, Cleft lip repair alone and lip simultaneous with hard palate repair using vomer flap in unilateral complete cleft lip and palate—a comparative study [Master of Surgery Thesis], Bangladesh Institute Child Health under University of Dhaka, 2007.
[2]
C. H. Rasul, M. A. Hassan, and M. S. Rahman, “Congenital anomalies in the newborn,” Journal of College of Phisician and Surgeon, vol. 16, no. 1, pp. 11–12, 1998.
[3]
C. P. Amal, Results of simultaneous correction of alar deformity with the primary repair of unilateral cleft lip [Master of Surgery Thesis], Bangabadhu Sk.Muzib Medical University, 2001.
[4]
G. Swennen, J. L. Berten, H. Schliephake et al., “Midfacial morphology in children with unilateral cleft lip and palate treated by different surgical protocols,” International Journal of Oral and Maxillofacial Surgery, vol. 31, no. 1, pp. 13–22, 2002.
[5]
K. Agrawal, “Cleft palate repair and variations,” Indian Journal of Plastic Surgery, vol. 42, no. 1, pp. S102–S109, 2009.
[6]
Y. F. Liao, T. J. Cole, and M. Mars, “Hard palate repair timing and facial growth in unilateral cleft lip and palate: a longitudinal study,” Cleft Palate-Craniofacial Journal, vol. 43, no. 5, pp. 547–556, 2006.
[7]
N. M. Samuel and K. T. C. Philip, “Unilateral cheiloplasty,” in Plastic Surgery. (Pediatric Plastic Surgery), J. S. Mathes, Ed., pp. 165–215, Elsevier, Philadelphia, Pa, USA, 2nd edition, 2006.
[8]
K. W. Butow, “Primary surgical repair of the palate,” in Treatment of Facial Cleft Deformities: An Illustrated Guide, W. Brian and M. F. A. Cochran, Eds., pp. 21–32, Ishiyaku Euro Amirica Inc, Tokyo, Japan, 1995.
[9]
W. Li, Q. Zheng, and S. Wei, “Simultaneous repair of cleft lip and closure of cleft hard palate with vomer flaps in patients with unilateral complete cleft lip and palate,” West China Journal of Stomatology, vol. 21, no. 1, pp. 34–47, 2003.
[10]
J. A. Lehman, B. K. Douglas, W. C. Ho, and T. W. Husami, “One-stage closure of the entire primary palate,” Plastic and Reconstructive Surgery, vol. 86, no. 4, pp. 675–681, 1990.
[11]
K. J. Lee, “Comprehensive surgical atlases,” in Otolaryngology and Head and Neck Surgery, pp. 101–262, Grune & Stratton, New York, NY, USA, 1983.
[12]
B. Richard, J. Russell, S. McMahon, and R. Pigott, “Results of randomized controlled trial of soft palate first versus hard palate first repair in unilateral complete cleft lip and palate,” Cleft Palate-Craniofacial Journal, vol. 43, no. 3, pp. 329–338, 2006.
[13]
A. De Mey, G. Swennen, C. Malevez, M. George, and A. L. Mansbach, “Long-term follow-up of UCLP at the Reine Fabiola Children's Hospital,” B-ENT, vol. 2, no. 4, pp. 44–50, 2006.
[14]
H. Sarwar, Cleft Palate in Children: surgery and outcome [Master of Surgery thesis], Bangladesh Institute Child Health under University of Dhaka, 1998.
[15]
C. D. Johnston, A. G. Leonard, D. J. Burden, and P. F. McSherry, “A comparison of craniofacial form in Northern Irish children with unilateral cleft lip and palate treated with different primary surgical techniques,” Cleft Palate-Craniofacial Journal, vol. 41, no. 1, pp. 42–46, 2004.
[16]
R. E. Kirschner, P. Randall, A. F. Jawad et al., “Cleft palate repair at 3 to 7 months of age,” Plastic and Reconstructive Surgery, vol. 105, no. 6, pp. 2127–2132, 2000.
[17]
K. Agrawal and K. N. Panda, “Use of vomer flap in palatoplasty: revisited,” Cleft Palate-Craniofacial Journal, vol. 43, no. 1, pp. 30–37, 2006.
[18]
S. H. Khundkar and M. A. Kalam, “Cleft palate repair: a modified procedure,” Journal Bangladesh College of Physician and Surgeon, vol. 16, no. 1, pp. 4–10, 1998.
[19]
S. R. Cohen, J. Kalinowski, D. LaRossa, and P. Randall, “Cleft palate fistulas: a multivariate statistical analysis of prevalence, etiology, and surgical management,” Plastic and Reconstructive Surgery, vol. 87, no. 6, pp. 1041–1047, 1991.
[20]
E. Diah, L. J. Lo, C. Yun, R. Wang, L. K. Wahyuni, and Y. R. Chen, “Cleft oronasal fistula: a review of treatment results and a surgical management algorithm proposal,” Chang Gung Medical Journal, vol. 30, no. 6, pp. 529–537, 2007.
