Does the Surgical Protocol Impact the Burden of Care of Patients With Cleft Lip and/or Palate?

AIM: To compare the burden of care in the first 7 years of life of patients with cleft lip and palate (CLP) treated with 2 different surgical protocols.

METHODS

The burden of care of patients with cleft palate (CP), unilateral (UCLP), and bilateral cleft lip and palate (BCLP), surgically treated with Protocol A (soft palate closure at 1 year with Veau-Wardill-Kilner pushback technique and hard palate closure between 5 and 7 years with Von Langenbeck procedure) and B (soft palate closure at 1 year with intravelar veloplasty by Sommerlad and hard palate closure using a vomer flap at time of lip repair) was compared. The burden of care was assessed from the patient's file from birth until 7 years old through the following disciplines: surgical, dental, audiological, logopedic, radiologic, and logistic. Group comparisons were performed using multivariable models with correction for confounders. Continuous and binary variables were analyzed with linear and logistic regression models respectively.

RESULTS

One hundred nineteen CLP patients were included (62 CP, 40 UCLP, and 17 BCLP). Sixty-eight were treated with protocol A and 51 with protocol B. Patients treated with protocol B spent less days in the hospital after surgery ( P =0.628), had less postsurgical complications ( P <0.001), lower need for secondary interventions ( P =0.016), needed less orthodontic maxillary expansion ( P =0.004), less ventilation tube insertions ( P <0.001), less speech therapy ( P <0.001), less extractions of deciduous teeth ( P = 0.040), less consultations ( P =0.008) and traveled less distance ( P =0.019). Patients treated with protocol A were younger when their first orthopantomogram ( P <0.001) and craniofacial x-rays ( P <0.001) were taken, and these radiographs were taken more often ( P =0.013 and <0.001, respectively).

CONCLUSIONS

Patients treated with protocol B experience a significantly lower burden of care in the first 7 years of life.