Perioperative Management in Patients With Cleft Lip and Palate.
Journal
The Journal of craniofacial surgery
ISSN: 1536-3732
Titre abrégé: J Craniofac Surg
Pays: United States
ID NLM: 9010410
Informations de publication
Date de publication:
Historique:
pubmed:
22
10
2019
medline:
14
3
2020
entrez:
22
10
2019
Statut:
ppublish
Résumé
In cleft care, perioperative treatment strategies like ear nose and throat (ENT) diagnostics as well as postoperative antibiotics, feeding, and duration of inpatient stay are nonstandardized procedures varying between different centers. Likewise, intraoperative choice of suture materials and time of suture removal are performed inconsistently. Therefore, we wanted to collect information on protocols focusing on these topics to summarize and subsume currently approved treatment strategies of centers around the world. We ask members of international cleft centers for their respective treatment strategies and performed descriptive statistics.Absorbable suture material is used for reconstruction of the outer lip skin in 20 of 70 centers. Removal of skin sutures is conducted after 7.0 ± 1.5 days. Suturing of the orbicularis oris muscle, the enoral and nasal mucosa, as well as the palatal musculature is predominantly performed with absorbable suture materials. Intraoperative antibiotic prophylaxis is applied in 82.9% of the participating centers. In contrast, 31.9% of the departments do not apply any antibiotic postoperatively. Postoperative feeding is performed in 27 centers via a nasogastric tube for 4.6 ± 2.3 days on average. Mean length of postoperative inpatient stay is 4.1 ± 2.6 days in children after cleft lip surgery and 4.5 ± 2.7 days after cleft palate surgery. ENT consultation before surgery is routinely conducted in 52.8% of the centers and 82.9% of ENT colleagues investigate middle ear pathologies in the same operation in which cleft repair is performed.Closure of the lip skin is predominantly performed with nonabsorbable suture material followed by a suture removal after 1 week. Intraoperative antibiotic prophylaxis as well as inpatient hospital stay of 4 to 5 days in combination with oral feeding and a preoperative consultation and intraoperative cooperation with the ENT department seems to be well-proven concepts in cleft lip palate patient care. However, this analysis illustrated the variations and differing approaches in perioperative care emphasizing the need to verify perioperative management concepts in cleft surgery-preferably in the context of multicenter studies.
Identifiants
pubmed: 31633673
doi: 10.1097/SCS.0000000000005897
pii: 00001665-202001000-00026
doi:
Types de publication
Journal Article
Langues
eng
Pagination
95-101Références
Thiele OC, Kreppel M, Dunsche A, et al. Current concepts in cleft care: a multicenter analysis. J Craniomaxillofac Surg 2018; 46:705–708.
Hotz MM. Pre- and early postoperative growth-guidance in cleft lip and palate cases by maxillary orthopedics (an alternative procedure to primary bone-grafting). Cleft Palate J 1969; 6:368–372.
Georgiade NG, Latham RA. Maxillary arch alignment in the bilateral cleft lip and palate infant, using pinned coaxial screw appliance. Plast Reconstr Surg 1975; 56:52–60.
Grayson BH, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg 1993; 92:1422–1423.
Barillas I, Dec W, Warren SM, et al. Nasoalveolar molding improves long-term nasal symmetry in complete unilateral cleft lip-cleft palate patients. Plast Reconstr Surg 2009; 123:1002–1006.
Garfinkle JS, King TW, Grayson BH, et al. A 12-year anthropometric evaluation of the nose in bilateral cleft lip-cleft palate patients following nasoalveolar molding and cutting bilateral cleft lip and nose reconstruction. Plast Reconstr Surg 2011; 127:1659–1667.
Rau A, Ritschl LM, Mucke T, et al. Nasoalveolar molding in cleft care—experience in 40 patients from a single centre in Germany. PLoS One 2015; 10:e0118103.
Uzel A, Alparslan ZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review. Cleft Palate Craniofac J 2011; 48:587–595.
van der Heijden P, Dijkstra PU, Stellingsma C, et al. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg 2013; 131:62e–71e.
Collin TW, Blyth K, Hodgkinson PD. Cleft lip repair without suture removal. J Plast Reconstr Aesthet Surg 2009; 62:1161–1165.
Woo AS. Evidence-based medicine: cleft palate. Plast Reconstr Surg 2017; 139:191e–203e.
Schonmeyr B, Wendby L, Campbell A. Early surgical complications after primary cleft lip repair: a report of 3108 consecutive cases. Cleft Palate Craniofac J 2015; 52:706–710.
Rossell-Perry P. Flap necrosis after palatoplasty in patients with cleft palate. BioMed Res Int 2015; 2015:516375.
Duarte GA, Ramos RB, Cardoso MC. Feeding methods for children with cleft lip and/or palate: a systematic review. Braz J Otorhinolaryngol 2016; 82:602–609.
Forsetlund L, Semb G, Farah MG, Flottorp S. NIPH Systematic Reviews: Executive Summaries. The Scientific Knowledge Base for Treatment of Patients with Cleft Lip, Alveolus and Palate. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health.(NIPH). Copyright (c)2009 by The Norwegian Institute of Public Health (NIPH). 2009.
Bekisz JM, Fryml E, Flores RL. A review of randomized controlled trials in cleft and craniofacial surgery. J Craniofac Surg 2018; 29:293–301.
Smyth AG, Knepil GJ. Prophylactic antibiotics and surgery for primary clefts. Br J Oral Maxillofac Surg 2008; 46:107–109.
Rottgers SA, Camison L, Mai R, et al. Antibiotic use in primary palatoplasty: a survey of practice patterns, assessment of efficacy, and proposed guidelines for use. Plast Reconstr Surg 2016; 137:574–582.
Kasatwar A, Borle R, Bhola N, et al. Prevalence of congenital cardiac anomalies in patients with cleft lip and palate—its implications in surgical management. J Oral Biol Craniofac Res 2018; 8:241–244.
Roode GJ, Butow KW, Naidoo S. Preoperative evaluation of micro-organisms in non-operated cleft in soft palate: impact on use of antibiotics. Br J Oral Maxillofac Surg 2017; 55:127–131.
Fahradyan A, Galdyn I, Azadgoli B, et al. To admit or not to admit: that is the cleft lip question. confirming the safety of outpatient cleft lip repair. Plast Reconstr Surg 2018; 142:159–168.
Kantar RS, Cammarata MJ, Rifkin WJ, et al. Outpatient versus inpatient primary cleft lip and palate surgery: analysis of early complications. Plast Reconstr Surg 2018; 141:697e–706e.
Matsunaka E, Ueki S, Makimoto K. Impact of breastfeeding or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: a systematic review protocol. JBI Database System Rev Implement Rep 2015; 13:3–11.
Maillard S, Retrouvey JM, Ahmed MK, et al. Correlation between nasoalveolar molding and surgical, aesthetic, functional and socioeconomic outcomes following primary repair surgery: a systematic review. J Oral Maxillofac Res 2017; 8:e2.