Mulliken John B, Zhu Deanna R, Sullivan Stephen R
Boston, Mass.; and Providence, R.I. From the Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School; the Division of Plastic and Reconstructive Surgery and the Department of Pediatrics, Warren Alpert Medical School of Brown University; and the Department of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital.
Plast Reconstr Surg. 2015 May;135(5):1439-1447. doi: 10.1097/PRS.0000000000001162.
Large numbers of international children with cleft lip-cleft palate are adopted in the United States; many underwent their first operation before arrival.
The authors reviewed records of internationally adopted children with cleft lip-cleft palate treated by one surgeon over 25 years. This study focused on anatomical types, frequency/methods of repair, correction of unrepaired deformities, and secondary procedures in this country.
Of 105 internationally adopted children with cleft lip-cleft palate, 91 percent were Asian; 75 percent had labial or labiopalatal closure in their native country. Of repaired unilateral cleft lips, 43 percent required complete revision, 49 percent required minor revisions, and 8 percent required no revision. All repaired bilateral cleft lips were revised; 90 percent were complete and 10 percent were minor. "Delayed" primary nasal correction was always necessary in both unilateral and bilateral forms. Labial closure was scheduled first in young infants with an unrepaired unilateral defect, whereas palatal closure took precedence in older children. Premaxillary setback and palatoplasty were scheduled first in older children with unrepaired bilateral cleft lip-cleft palate. Of children arriving with repaired palate, 43 percent required a pharyngeal flap.
Whenever cleft lip-cleft palate is repaired in another country, revision rates are high for both unilateral and bilateral types. Nevertheless, primary closure in the native country may increase the likelihood for adoption. Traditional surgical protocols often are altered for an adoptee with an unrepaired cleft lip-cleft palate, particularly the sequence of labial and palatal closure, depending on the child's age and type of defect.
大量患有唇腭裂的国际儿童被美国收养；许多儿童在抵达美国之前就已经接受了首次手术。
作者回顾了一位外科医生在25年里治疗的国际收养唇腭裂儿童的记录。本研究聚焦于解剖类型、修复频率/方法、未修复畸形的矫正以及在美国进行的二次手术。
在105名国际收养的唇腭裂儿童中，91%为亚洲人；75%在其本国接受了唇部或唇腭裂修复。在修复的单侧唇裂中，43%需要完全修复，49%需要小修复，8%无需修复。所有修复的双侧唇裂均进行了修复；90%为完全修复，10%为小修复。单侧和双侧唇裂均始终需要进行“延迟”一期鼻矫正。对于单侧未修复缺损的幼儿，首先安排唇部修复，而对于年龄较大的儿童，腭裂修复优先。对于双侧唇腭裂未修复的大龄儿童，首先安排前颌后缩和腭裂修复术。在抵达时已修复腭裂的儿童中，43%需要咽瓣。
无论唇腭裂在其他国家何时修复，单侧和双侧类型的修复率都很高。然而，在本国进行一期修复可能会增加被收养的可能性。对于唇腭裂未修复的被收养者，传统的手术方案通常会改变，尤其是唇部和腭裂修复的顺序，这取决于儿童的年龄和缺损类型。
