From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Ann Plast Surg. 2023 May 1;90(5S Suppl 3):S312-S314. doi: 10.1097/SAP.0000000000003399. Epub 2023 Apr 1.
Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR.
Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded.
Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027).
Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.
唇腭裂是头颈部最常见的先天性缺陷，每 700 例活产中就有 1 例。通过常规或三维超声检查，通常在子宫内即可诊断。自 2015 年以来，洛杉矶儿童医院一直采用早期唇裂修复术（ECLR）（<3 个月大）治疗单侧唇裂（UCL），无论唇裂宽度如何，作为唇裂重建的主要方法。传统的唇裂修复术（TLR）历史上在 3 至 6 个月大时进行±术前鼻牙槽塑形术（NAM）。先前的出版物强调了 ECLR 的益处，例如增强美学效果、降低修复率、更好的体重增加、增加牙槽裂的接近度、节省 NAM 成本以及提高家长满意度。偶尔，家长会接受产前咨询以讨论 ECLR。本研究评估唇裂诊断、术前手术咨询和转诊模式的时间，以验证产前诊断和产前咨询是否导致 ECLR。
回顾性研究评估了 2009 年至 2020 年间接受 ECLR 与 TLR±NAM 的患者。提取修复时间、唇裂诊断和手术咨询以及转诊模式。纳入标准为：ECLR 年龄<3 个月，TLR 年龄 3 至 6 个月，无重大合并症，诊断为 UCL 无腭裂。排除双侧唇裂或颅面综合征患者。
107 例患者中，51 例（47.7%）行 ECLR，56 例行 TLR（52.3%）。ECLR 组的平均手术年龄为 31.8 天，TLR 组为 112 天。此外，70.1%的患者为产前诊断，但只有 5.6%的家庭进行了唇裂修复的产前咨询，100%的家庭进行了 ECLR。大多数患者由儿科医生转诊（72.9%）。产前咨询与 ECLR 的发生率之间存在统计学意义（P=0.008）。此外，产前诊断与 ECLR 的发生率呈显著相关（P=0.027）。
我们的数据表明，UCL 的产前诊断与 ECLR 发生率之间存在统计学意义。因此，我们提倡向转诊医生提供有关 ECLR 的教育，并提倡在产前进行手术咨询，希望家庭能够享受到 ECLR 的诸多益处。
