Continuous circular closure in unilateral cleft lip and plate repair in one surgery

Benito K Benitez; Andrzej Brudnicki; Zbigniew Surowiec; Ravi K Singh; Prasad Nalabothu; Dieter Schumann; Andreas A Mueller

doi:10.1016/j.jcms.2021.07.002

Continuous circular closure in unilateral cleft lip and plate repair in one surgery

J Craniomaxillofac Surg. 2022 Jan;50(1):76-85. doi: 10.1016/j.jcms.2021.07.002. Epub 2021 Aug 3.

Authors

Benito K Benitez¹, Andrzej Brudnicki², Zbigniew Surowiec³, Ravi K Singh⁴, Prasad Nalabothu⁵, Dieter Schumann⁶, Andreas A Mueller⁷

Affiliations

¹ Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland. Electronic address: benito.benitez@usb.ch.
² Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, Child, Ul. Kasprzaka 17a, 01-211, Warsaw, Poland. Electronic address: abrudnicki@poczta.fm.
³ Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, Child, Ul. Kasprzaka 17a, 01-211, Warsaw, Poland. Electronic address: zsuro@op.pl.
⁴ Maxillofacial Surgery, Peace Point Hospital, Pvt Ltd, 72 Jawahar Nagar, Bhelupur, 221055, Varanasi, India. Electronic address: kantravi16@gmail.com.
⁵ Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland. Electronic address: prasad.nalabothu@unibas.ch.
⁶ Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland. Electronic address: profdschumann@googlemail.com.
⁷ Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Department of Clinical Research, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Gewerbestrasse 14, 4123, Allschwil, Switzerland. Electronic address: andreas.mueller@usb.ch.

PMID: 34896005
DOI: 10.1016/j.jcms.2021.07.002

Abstract

The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.

Keywords: Craniofacial malformation; One-stage repair; Orofacial cleft; Surgical repair; Treatment burden; Unilateral cleft lip and palate.

MeSH terms

Cleft Lip* / surgery
Cleft Palate* / surgery
Cohort Studies
Humans
Infant
Infant, Newborn
Lip
Retrospective Studies

Associated data

ClinicalTrials.gov/NCT04108416