Incidence of complications during the initial years of formation of a cleft lip and palate service

▪ ABSTRACT

Introduction:

Cleft lip and palate is the most common congenital craniofacial malformation. Difficulties in eating, speaking, and hearing are common in these patients, requiring multidisciplinary treatment, which makes it difficult to create and maintain specialized services. The diversity of classifications and the large number of surgical techniques used in primary surgeries (cheiloplasty and palatoplasty) make it difficult to compare epidemiological data and complications between services, and there is a lack of studies evaluating newly created specialized centers for cleft lip and palate.

Method:

A prospective cohort study was carried out with patients diagnosed with cleft lip and palate who underwent primary surgical procedures at the Hospital de Clínicas of the Universidade Federal de Uberlândia, between July 2017 and February 2023. Patients under 18 years of age with follow-up were included. post-operative period of at least 3 months.

Results:

79 patients participated in the study, who underwent 115 primary surgeries (54 cheiloplasties and 61 palatoplasties). 11 complications were reported in this period: 2 dehiscences in cheiloplasty (3.70%), 1 hypertrophic scar in cheiloplasty (1.85%), 6 fistulas in palatoplasty (9.83%) and 2 dehiscences in palatoplasty (3.28%). The incidence of complications was 9.56% when analyzing the total number of surgeries, being 5.55% in patients undergoing cheiloplasty and 13.11% in patients undergoing palatoplasty.

Conclusion:

The incidence of complications during the initial years of structuring the service was similar to other studies in the literature.

Keywords:

Cleft palate - Cleft lip - Craniofacial abnormalities - Fistula - Postoperative complications

INTRODUCTION

Cleft lip and palate is the most common congenital craniofacial malformation, with an estimated prevalence of 1 case in every 700 live births. Feeding difficulties, speech changes, and hearing disorders are common in these patients, making appropriate multidisciplinary treatment generally involving plastic surgery, otorhinolaryngology, speech therapy, physiotherapy, orthodontics, nursing, and psychology. The need for different specialties makes it difficult to create and maintain specialized services in this condition[1] [2].

The diversity of classifications and the large number of surgical techniques used in primary surgeries (cheiloplasty and palatoplasty) make it difficult to compare epidemiological data between specialized services and assess the incidence of complications associated with these surgeries.

Although many studies have evaluated the incidence of complications in patients undergoing cheiloplasty and palatoplasty, there is little work carried out in specialized centers with shorter creation times[3] [4] [5] [6] [7] [8] [9].

OBJECTIVE

The objective of this work was to evaluate the epidemiological profile and the incidence of complications in patients with cleft lip and palate undergoing surgical correction at the Hospital de Clínicas of the Universidade Federal de Uberlândia (HC-UFU), in Uberlândia-MG, during the initial years of structuring the treatment service for patients with cleft lip and palate (composed of a plastic and craniomaxillofacial surgeon, otorhinolaryngology team, speech therapist, dentist and residents in craniomaxillofacial surgery and otorhinolaryngology).

MATERIALS AND METHODS

A prospective cohort study was carried out with patients diagnosed with cleft lip and palate who underwent primary surgical procedures, by the same surgeon, accompanied by residents in cranio-maxillofacial surgery, at HC-UFU, from July 2017 to February 2017. 2023.

Patients under 18 years of age who underwent primary surgical procedures (cheiloplasty and/or palatoplasty) and who had postoperative follow-up of at least 3 months during the analyzed period were included.

Patients aged 18 years or older and undergoing other surgical procedures were excluded from the study.

The following data was collected: date of birth, date of surgery, classification of the type of cleft lip and palate (using Veau’s classification), type(s) of surgery(s) performed, and complications associated with the procedures. Parents or guardians signed an informed consent form before surgery, agreeing with the surgical procedures and authorizing the use of data. This study was approved by the institution’s Research Ethics Committee, under number 57032022.5.0000.5152.

Exclusively descriptive statistics were used for epidemiological characterization and determination of the incidence of complications.

RESULTS

During the period analyzed, 79 patients diagnosed with cleft lip and palate were monitored and underwent 115 primary surgeries (54 cheiloplasties and 61 palatoplasties).

Among the patients followed, 15 patients (18.98%) had Veau classification type I, 12 patients (15.18%) had type II, 31 patients (39.24%) had type III, and 21 patients (26.58%) type IV ([Table 1]).

Table 1.

Classification (Veau)	Number of cases	Percentage
Type 1	15	18.98%
Type 2	12	15.18%
Type 3	31	39.24%
Type 4	21	26.58%
Total	79

The techniques used in cheiloplasty were Fisher in 35 cases (64.81%), Mulliken (bilateral) in 2 cases (3.70%), and lip adhesion in 15 cases (27.78%) ([Table 2]).

Table 2.

Techniques surgical	Number of cases	Percentage
Cheiloplasty
Fisher	35	64.81%
Lip adhesion	17	27.78%
Mulliken (bilateral)	2	3.70%
Total	54
Palatoplasty
Bardach (two flaps)	38	62.29%
Von Langenbeck	20	32.78%
Furlow	3	4.92%
Total	61

The techniques used in palatoplasty were: Bardach (two flaps) in 38 patients (62.29%), Von Langenbeck in 20 patients (32.78%), and Furlow in 3 patients (4.92%). In 5 patients (8.19%) the vomer flap was associated ([Table 2]).

Eleven complications were reported in this period: 2 dehiscences in cheiloplasty (3.70%), 1 hypertrophic scar in cheiloplasty (1.85%), 6 fistula in palatoplasty (9.83%), and 2 dehiscences in palatoplasty (3.28% ) ([Table 3]).

Table 3.

Complications	Number of cases	Percentage
Cheiloplasty
Dehiscence	2	3.70%
Hypertrophic scar	1	1.85%
Total	3	5.55%
Palatoplasty
Fistula	6	9.83%
Dehiscence	2	3.28%
Total	8	13.11%

The incidence of complications was 9.56% when analyzing the total number of surgeries, 5.55% in patients undergoing cheiloplasty, and 13.11% in patients undergoing palatoplasty.

DISCUSSION

This work evaluated the epidemiological profile and the incidence of complications in patients with CLP undergoing primary surgery in the initial years of structuring the cleft lip and palate service at HC-UFU.

The comparison of the incidence of total complications is limited in the literature because studies consider different occurrences as complications (some studies consider, for example, the presence of fever in the postoperative period as a complication). Despite the difference in criteria, our incidence of 9.56% is lower than the work carried out by Gatti et al.[10], which presented an incidence of 14.16%.

Regarding cheiloplasty, recent studies show the presence of complications ranging between 4.4% and 40%, while we present 5.55%[3] [6] [7] [11]. The presence of dehiscence in cheiloplasty varies between 3.2% and 15.4% of patients, while we observed it in 3.70%[3] [11]. Hypertrophic scarring in 14.9%, while in our patients it was 1.85%[11].

In palatoplasty, the total incidence of complications varies greatly in recent literature (15.8% to 70%); our incidence was 13.11%[5] [6] [7]. Fistula development occurs in 2.4% to 28% of patients and, in our service, the incidence was 9.83%[4] [5] [11] [12] [13] [14] [15] [16] [17]. The presence of dehiscence in palatoplasty varies between 0.7% and 4%, while we present 3.28%[5] [12] [18].

Recent studies show that surgical volume (above 25 surgeries/year) as well as the surgeon’s experience influence the reduction of complications in patients with cleft lip and palate[18] [19].

Our work has important limitations (number of patients due to the recent structuring of the service, only one surgeon with experience in cleft lip and palate, difficulty in comparing with other studies due to the variation in diagnostic criteria and complications, and variability of surgical techniques used in each service) and, despite these limitations, the incidence of complications was similar to studies in already consolidated centers.

CONCLUSION

Our study showed an incidence of complications similar to that of other established centers and long-term follow-up is necessary to assess the possibility of reducing complications with increased surgical volume and greater experience.

Conflicts of interest:

none.

Institution: Hospital das Clínicas da Universidade Federal de Uberlândia (EBSERH), Uberlândia, MG, Brazil.

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Publication History

Received: 14 September 2023

Accepted: 04 February 2024

Article published online:
20 May 2025