Walsh Kyle, Foy Clare
Anatomy, Queen's University of Belfast, Belfast, GBR.
School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, GBR.
Cureus. 2025 Sep 21;17(9):e92858. doi: 10.7759/cureus.92858. eCollection 2025 Sep.
Cleft lip and palate (CLP) abnormalities are common birth defects encompassing isolated cleft lip, cleft palate, or combined CLP. Current knowledge indicates that CLP has both genetic and environmental causes, with strong associations between a positive family history and maternal factors such as smoking, alcohol consumption, teratogenic substance use, and poor nutrition. The upper lip develops as a result of the fusion of the paired medial nasal prominences to the maxillary prominences, forming the philtrum and lateral portions of the upper lip, respectively. Cleft lip, therefore, arises from a failure in those named structures to fuse. The current best treatment involves surgical repair to reconstruct the lip to restore normal appearance and function, including feeding and speech. This normally occurs around the age of six months (standard time) in most centers, but is performed much earlier, in the neonatal period, in other centers. This study aims to determine whether neonatal cleft lip repair is superior to standard time repair. Secondary aims are to determine both the feasibility and the safety of neonatal repair. Advanced literature searches were carried out using Medline ALL (1946 to date) and Embase (1974 to date); 11 articles were deemed relevant and included in this study. Aesthetic results showed excellent outcomes with neonatal repair with regard to the appearance of the scar, facial (lip and nasal) symmetry, but those aesthetic results are no better than those achieved at standard time. Although early intervention can be beneficial as early repair takes place when the cleft is less severe and when the tissues are more malleable, making the surgery less challenging, and when some aspects of fetal scar healing remain. Additionally, early repair has a positive impact on the development of the alveolar projections and can assist in reducing an alveolar cleft if present, improving the aesthetic outcome. Moreover, neonatal surgery carries with it no greater risk than surgery carried out at six months and will allow feeding to begin at an early stage, promoting recovery. Early repair also brings with it a large positive psychosocial impact, where infants and mothers can build a normal relationship from an early stage. Later in life, children and adults will be less self-conscious following good aesthetic repair. In conclusion, based on the limited available evidence, neonatal repair may be recommended over standard time repair.
唇腭裂（CLP）异常是常见的出生缺陷，包括单纯性唇裂、腭裂或唇腭裂合并症。目前的知识表明，唇腭裂既有遗传因素，也有环境因素，家族史阳性与母亲因素如吸烟、饮酒、使用致畸物质及营养不良之间存在密切关联。上唇是由成对的内侧鼻突与上颌突融合而成，分别形成人中及上唇的外侧部分。因此，唇裂是由于这些特定结构未能融合所致。目前最佳的治疗方法是手术修复，以重建唇部，恢复正常外观和功能，包括进食和言语功能。在大多数中心，这通常在六个月左右（标准时间）进行，但在其他中心则在新生儿期进行得更早。本研究旨在确定新生儿唇裂修复是否优于标准时间修复。次要目的是确定新生儿修复的可行性和安全性。使用Medline ALL（1946年至今）和Embase（1974年至今）进行了全面的文献检索；11篇文章被认为相关并纳入本研究。美学结果显示，新生儿修复在瘢痕外观、面部（唇部和鼻部）对称性方面效果极佳，但这些美学结果并不优于标准时间修复。尽管早期干预可能有益，因为早期修复是在腭裂不太严重、组织更具可塑性时进行，使手术难度降低，且胎儿瘢痕愈合的某些方面仍然存在。此外，早期修复对牙槽突的发育有积极影响，如果存在牙槽裂，可有助于减少牙槽裂，改善美学效果。此外，新生儿手术的风险并不高于六个月时进行的手术，并且可以早期开始喂养，促进恢复。早期修复还带来了巨大的积极心理社会影响，婴儿和母亲可以从早期就建立正常的关系。在以后的生活中，经过良好的美学修复，儿童和成人的自我意识会降低。总之，基于有限的现有证据，可能推荐新生儿修复而非标准时间修复。
