[Combined interventions in primary management of patients with lip-jaw-palatal clefts].

BACKGROUND

The continuing improvement in the care and treatment of cleft lip and palate in infants raises the question of whether the total number of surgical steps in primary cleft repair could be reduced without additional risk to the patients. A total of 108 patients, born between 1985 and 1997 with complete cleft lip and palate, were evaluated in this study. The patients were treated at the Department of Oral and Maxillofacial Surgery of the Ruhr-University Bochum with 106 "combined" (group A, n = 54) and 141 "separated" (group B, n = 54) operations. The newer "combined" strategy, with several surgical steps conducted in one operation, was compared with the older "separated" procedures by analysis of various peri- and postoperative parameters.

RESULTS

Patient groups A and B were differentiated by the following operation related data: 1st primary operation: age: 5.8 vs 4.6 months (P < 0.01), weight: 6.8 vs 6.5 kg (P = 0.2); 2nd primary operation: age: 13.9 vs 9.6 months (P < 0.01), weight: 9.2 vs 8.5 kg (P = 0.16); total intraoperative blood loss: 122 vs 147 ml, (P = 0.16); total time during which the patient was operated: 4.9 vs 5.4 h (P = 0.17); peri- and postoperative rate of complications: 14 vs 15% (P = 0.87) for the first primary and .27 vs 28% (P = 0.96) for the second primary operation; rate of wound dehiscence: 18 vs 13% (P = 0.66); total time hospitalized: 27 vs 34 days (P = 0.01).

DISCUSSION: The "combined" surgical procedures reduced the number of surgical interventions under general anaesthesia and led to a significant reduction of the overall blood loss and hospitalisation. A slightly higher age at the first intervention made the minor increase in blood loss tolerable. The rate of perioperative complications showed no increase.