Postoperative complications in cleft lip and palate: a retrospective study at the General Hospital of México (2021-2023)

Melissa De Anda Hidalgo; Emiliano O. Chang; Maria Jose Corona; Santos E. Platas Galvan; Silverio Tovar Zamudio

doi:10.18203/2320-6012.ijrms20252007

Authors

Melissa De Anda Hidalgo Department of Plastic and Reconstructive Surgery, Hospital General de México, Mexico-City, México
Emiliano O. Chang Department of Plastic and Reconstructive Surgery, Hospital General de México, Mexico-City, México
Maria Jose Corona Department of Plastic and Reconstructive Surgery, Hospital General de México, Mexico-City, México
Santos E. Platas Galvan Department of Plastic and Reconstructive Surgery, Hospital General de México, Mexico-City, México
Silverio Tovar Zamudio Department of Plastic and Reconstructive Surgery, Hospital General de México, Mexico-City, México

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252007

Keywords:

Cleft lip surgery, Cleft palate repair, Postoperative complications, Palatal fistula, Velopharyngeal insufficiency

Abstract

Background: Cleft lip and palate (CLP) are among the most prevalent congenital malformations globally, with particularly high rates in low- and middle-income countries such as Mexico. While early surgical intervention can restore function and aesthetics, postoperative complications remain a clinical challenge. This study aims to identify the frequency and types of complications in patients referred to the General Hospital of Mexico between 2021 and 2023 following primary CLP surgery in other institutions.

Methods: A retrospective review was conducted on 122 patients with CLP sequelae referred to the Plastic and Reconstructive Surgery Department at the General Hospital of Mexico from 2021 to 2023. Medical records were analyzed to determine the type and frequency of postoperative complications. Only patients with documented complications were included.

Results: Among 122 cases, the most frequent complications were short lip (44.3%), palatal fistula (32.8%), and velopharyngeal insufficiency (19.7%). Less common issues included respiratory difficulty, lip paresthesia, dehiscence, and hypertrophic scarring (0.8% each). Complications were most often associated with patients undergoing both cheiloplasty and palatoplasty. Those with two surgeries had the highest relative risk for short lip (RR=4.0), velopharyngeal insufficiency (RR=2.2), and palatal fistula (RR≈1.92). Patients undergoing only one surgery had notably fewer complications.

Conclusions: High-quality initial surgical repair is critical in preventing postoperative complications. Our findings highlight the importance of optimizing the first surgical intervention to reduce the need for additional procedures and improve long-term outcomes in CLP patients.

Metrics

Metrics Loading ...

References

Romero M, Saez JM. Scope of Western surgical techniques to correct cleft lip and palate prior to the 18th century. Cleft Palate Craniofac J. 2014;51(5):497-500. DOI: https://doi.org/10.1597/13-138

Qiu WL. Treatment of cleft lip and cleft palate. Chin Med J (Engl). 1991;104(5):432-6.

Bill J, Proff P, Bayerlein T, Weingaertner J, Fanghänel J, Reuther J. Treatment of patients with cleft lip, alveolus and palate—a short outline of history and current interdisciplinary treatment approaches. J Craniomaxillofac Surg. 2006;34 Suppl 2:17-21. DOI: https://doi.org/10.1016/S1010-5182(06)60005-X

Raghuram AC, Jacob L, Wlodarczyk JR, et al. The Evolution of Unilateral Cleft Lip Repair. J Craniofac Surg. 2021;32(6):2068-73. DOI: https://doi.org/10.1097/SCS.0000000000007635

Vig KW, Mercado AM. Overview of orthodontic care for children with cleft lip and palate, 1915-2015. Am J Orthod Dentofacial Orthop. 2015;148(4):543-56. DOI: https://doi.org/10.1016/j.ajodo.2015.07.021

Cerón-Zamora E, Scougall-Vilchis RJ, Contreras-Bulnes R. Trends in cleft lip and/or palate prevalence at birth in Mexico: A national (ecological) study between 2003 and 2019. Cleft Palate Craniofac J. 2023;60(11):1353-8. DOI: https://doi.org/10.1177/10556656221106881

Soedjana H, Bangun K, Christine S. Evaluating psychosocial problems in school-age children with cleft lip and palate in Bandung, Indonesia using CBCL/6-18. Cleft Palate Craniofac J. 2022;59(10):1246-52. DOI: https://doi.org/10.1177/10556656211040703

Salari N, Darvishi N, Heydari M. Global prevalence of cleft palate, cleft lip, and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2022;123:110-20. DOI: https://doi.org/10.1016/j.jormas.2021.05.008

Escher PJ, Zavala H, Lee D. Malnutrition as a risk factor in cleft lip and palate surgery. Laryngoscope. 2021;131(6):1350-5. DOI: https://doi.org/10.1002/lary.29209

Miranda BL, de Araújo Júnior JL, de Paiva MAF, Lacerda RHW, Vieira AR. Management of oronasal fistulas in patients with cleft lip and palate. J Craniofac Surg. 2020;31(6):e465-70. DOI: https://doi.org/10.1097/SCS.0000000000006213

Ma Y, Liu H, Shi L. Progress of epigenetic modification of SATB2 gene in the pathogenesis of non-syndromic cleft lip and palate. Asian J Surg. 2024;47:72-6. DOI: https://doi.org/10.1016/j.asjsur.2023.09.113

Kruppa K, Krüger E, Vorster C, van der Linde J. Cleft lip and/or palate and associated risks in lower-middle-income countries: A systematic review. Cleft Palate Craniofac J. 2022;59(5):568-76. DOI: https://doi.org/10.1177/10556656211018952

Swanson MA, Auslander A, Morales T. Predictors of complication following cleft lip and palate surgery in a low-resource setting: A prospective outcomes study in Nicaragua. Cleft Palate Craniofac J. 2022;59(12):1452-60. DOI: https://doi.org/10.1177/10556656211046810

Darjazini Nahas L, Hmadieh M, Audeh M. Cleft lip and palate risk factors among otorhinolaryngology: Head and neck surgery patients in two hospitals. Medicine (Baltimore). 2023;102(42):e34419. DOI: https://doi.org/10.1097/MD.0000000000034419

Hashemi Hosseinabad H, Derakhshandeh F, Mostaajeran F, Abdali H, Davari HA, Hassanzadeh A, et al. Incidence of velopharyngeal insufficiency and oronasal fistulae after cleft palate repair: A retrospective study of children referred to Isfahan Cleft Care Team between 2005 and 2009. Int J Pediatr Otorhinolaryngol. 2015;79(10):1722–6. DOI: https://doi.org/10.1016/j.ijporl.2015.07.035

Jodeh DS, Nguyen ATH, Rottgers SA. Outcomes of primary palatoplasty: An analysis using the Pediatric Health Information System database. Plast Reconstr Surg. 2019;143(2):533–9. DOI: https://doi.org/10.1097/PRS.0000000000005210

Losee JE, Smith DM, Afifi AM, Jiang S, Ford M, Vecchione L, et al. A successful algorithm for limiting postoperative fistulae following palatal procedures in the patient with orofacial clefting. Plast Reconstr Surg. 2008;122(2):544–54. DOI: https://doi.org/10.1097/PRS.0b013e31817d6223

Sink J, Turner L, Nguyen H. A universal classification system for postoperative complications in cleft lip and palate surgery. Cleft Palate Craniofac J. 2021;58(3):338–46.

Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773–85. DOI: https://doi.org/10.1016/S0140-6736(09)60695-4

Poenaru D, Lin DT, Corlew DS. The burden of surgically correctable disabilities among children in low-income countries. J Pediatr Surg. 2015;50(2):370–6.