Surgical management of cleft lip and palate in young children: An umbrella review.

BACKGROUND

Cleft lip and/or palate (CLP) is one of the most prevalent congenital craniofacial anomalies, with a global incidence of approximately 1 in 700-1000 live births. Surgical management varies substantially across centers in technique, timing, and perioperative care, which complicates evidence-based standardization.

OBJECTIVE

To synthesize high-level evidence from systematic reviews and meta-analyses on the surgical and perioperative management of CLP in children aged 0-6 years, with emphasis on technique comparisons, key clinical outcomes, and analgesic protocols.

MATERIALS AND

METHODS

A systematic search of PubMed/MEDLINE, Embase, and Scopus (2010-2026) identified eligible systematic reviews and meta-analyses. Study selection, data extraction, and quality appraisal were performed independently by two reviewers using AMSTAR 2 and the GRADE framework. Overlap across included reviews was quantified using the corrected covered area (CCA) method.

RESULTS

Eleven systematic reviews and meta-analyses (n = 6463+ patients) met inclusion criteria. The Furlow double-opposing Z-plasty was associated with significantly lower fistula and velopharyngeal insufficiency (VPI) rates, compared with alternative palatoplasty techniques. One-stage palatoplasty reduced fistula and VPI risk in the two-stage repair. Intraoperative nerve blocks demonstrated robust opioid-sparing effects; the PROSPECT Working Group endorses suprazygomatic maxillary blocks combined with acetaminophen and NSAIDs as the recommended perioperative analgesic strategy. GRADE certainty was high for pain management and moderate-to-low for speech and facial growth outcomes.

CONCLUSIONS

No single palatoplasty technique is universally superior across all clinically relevant outcomes. Furlow palatoplasty demonstrates consistent advantages for fistula and VPI reduction based on moderate certainty evidence, and multimodal analgesia incorporating nerve blocks should be considered standard perioperative practice. Standardized outcome measures and multicenter studies are needed to advance evidence-based cleft care.