In the treatment of cleft lip and palate, one operation is often not enough

While cleft lips and cleft palates are the most common congenital structural abnormalities in the facial region, the optimal surgical procedure and its timing remain to be determined.

In the treatment of cleft palate, one operation to repair the cleft is often not enough. Instead, subsequent surgical procedures are often needed as the child grows older. Particularly, the need for corrective surgery is the greatest in the case of extensive and severe clefts. This is demonstrated by a recently completed doctoral thesis to be examined at the University of Helsinki in December.

“The evidence of any mistakes potentially made in the first operation will only manifest as the child grows older,” says Doctoral Researcher Charlotta Gustafsson-Silén, a doctor specialising in plastic surgery.

“The goals of surgical intervention are proper speech, hearing, occlusion and appearance. If the treatment outcome is not good, it may have a detrimental effect on the child’s social relationships.”

According to Gustafsson-Silén, it is still unclear which surgical method and timing would provide the best preconditions for the development of speech and growth of the facial structures, and the lowest risk of adverse effects such as dehiscence in the form of a palatal fistula.

“Good primary surgery can minimise the risk for complications and reduce the subsequent need for corrective surgeries. Minimising the surgical burden for the child is also an important aspect of modern cleft care. It is also cost-efficient for society.”

Minor long-term differences between surgical procedures

In her doctoral thesis, Gustafsson-Silén examined the long-term need for subsequent corrective surgery in patients with different types of clefts. The study focused on speech-correcting surgeries and the need to repair any palatal fistulas remaining after surgery. These repair needs can be used as a measure of success in primary surgery. She also compared different surgical interventions that have been utilized in Finland over the past decades.

The dataset was composed of data pertaining to 872 patients collected from the patient archive of the Cleft Palate and Craniofacial Center HUSUKE. The background information of the patients was obtained from medical reports and electronic patient databases.

In the end, long-term differences between the various closure techniques and methods were minor according to the study.

“Since the learning-curve is long in cleft surgery, you can justifiably ask whether surgeons should focus on a single surgical technique with which they are familiar instead of switching to new ones that take time to learn. Changing the technique does not necessarily bring marked benefits,” Gustafsson-Silén says.

Lip and palate clefts are the most common congenital structural abnormalities in the facial region.

Each year, some 120 cases occur in Finland, with the majority being cleft palates. In Finland, the treatment of clefts has been centralised in two cleft centres located in the university hospitals in Helsinki and Oulu.

Public examination of a doctoral dissertation

Charlotta Gustafsson-Silén, LicMedSci, will defend her doctoral thesis entitled ‘Surgical treatment and long-term outcomes of cleft lip and palate’ on 16 December 2022 at the Faculty of Medicine, University of Helsinki. The public examination will take place in the Niilo Hallman room of the Park Hospital on Meilahti Campus (Stenbäckinkatu 11). Professor György Kálmán Sándor will serve as the opponent and Professor Virve Koljonen as the custos.

The doctoral thesis is available online in the Helda repository.

Further information:

Charlotta Gustafsson-Silén
Specialising doctor