Treatment / Timing

New trends in the complex treatment in the Cleft Centre in Bratislava

[Summary] ((New trends in the complex treatment in the Cleft Centre in Bratislava. Kokavec R, Hedera J, Fedeles J, Janovic J, Kratka E, Klimova Bratisl Lek Listy 2001; 102 (6): 290-293. Complete text: (verified 22 March 2007) ))
This study focuses on the following issues: cleft incidence, timing of the primary surgical repair, as well as the need of secondary operations (closures of communications, bone grafts, pharyngeal flaps, corrections of the lip and nose) and the achieved standard of speech quality and articulation, as well as on the early and late otological states and phonation.

Practice at the National Cleft Centre, Bratislava:
Surgeons at the National Cleft Centre, Bratislava, prefer a 2-stage closure of the cleft lip and palate. The first stage (at 3-6 months) involves lip closure, while the second stage (after 6 months) involves closure of the palate.

About one half (46.4 %) of all cases of clefts of the primary palate at the treatment centre require a bone graft for the fulfillment of the gap in the dentoalveolar arch. The timing of the operation coincides with the eruption of the definitive canine.

The clinical analysis of secondary corrections indicated that the need for lip correction was in 18.2% of patients, for corrective rhinoplasty in 22.3%, for septorhinoplasty in 9% and for pharyngeal flap in 10.1% of patients. The occurrence of the vestibulonasal and oronasal communications was in 23.2% of patients. The average age for bone grafting was 14 years.

The efforts of the Centre aimed towards the continuous therapy of speech and hearing failures is most intensive between the age of 3 to 6. This, the study states, is due to the need for maximum improvement in articulation at the pre-school age.

Claims in Relation to Worldwide Treatment and Trends:
The study states as a precursor to its discussion that there are numerous concepts of comprehensive treatment of cleft anomalies and that comparison between the individual concepts is very difficult. There is, however, a global tendency for the medical care to concentrate into cleft centers, where special interdisciplinary teams comprising experts from such fields as plastic surgery, anesthesiology, maxillofacial surgery, orthodontics, phonetics, speech therapy, paediatrics, human genetics or teratology.

In relation to primary repair, the study state that the tendency worldwide is to perform the primary cleft operations as soon as possible after birth (i.e. to close the cleft completely prior to the age of 1).

The study also claims that there is a tendency towards the one-stage closure of the cleft lip and palate, in other words all in one single operation. According to the study, the main advantage of this concept is the ‘omission of at least one anesthesia and hospitalization, with consequential minimalization of potential undesirable impacts and less stress for the kid and for the parents’ (quote). Reduced costs is also given as an advantage of this approach. The study further claims that ‘an operation in unscarred tissue and an early reconstruction of the muscular system in soft palate lead to better speech and hearing development and prevent the potential dislocation of maxillary segments’ (quote).

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