Objective: Evaluating the safety and outcomes of premaxillary setback with posterior vomerine ostectomy in single-stage repair of complete bilateral cleft lip (CBCL) with severe premaxillary protrusion. Design: Retrospective case series. Setting: Multiple outreach surgical sites. Patients/Participants: From 2012 to 2016, 41 patients with CBCL and severe premaxillary protrusion underwent posterior vomerine premaxillary setback (PVPS) by a single surgeon in Brazil, Ecuador, and Peru. Patients 4 months to 18 years old undergoing primary or revision CBCL surgery were eligible for inclusion in the study. Patients with diagnosed syndromes were excluded. Interventions: Posterior vomerine premaxillary setback. Main Outcome Measures: Postoperative complications and postoperative aesthetic outcomes. Results: The mean age at surgery was 3.7 ± 3.8 years, with an average follow-up time of 17.0 ± 13.9 months. Patients underwent their procedures in Brazil (71%), Ecuador (22%), and Peru (7%). The majority of patients were aged 2 years or less (56%), were males (54%), had undergone prior surgery (56%), and had not undergone preoperative surgical orthopedics (95%). None of the patients developed major complications. All patients were able to undergo PVPS with concomitant required procedures and had good aesthetic outcomes. Conclusions: Few reports have evaluated single-stage CBCL repair or revision with severe premaxillary protrusion using PVPS. Our study shows that this technique is safe and results in good aesthetic outcomes. Further follow-up with anthropometric patient data is needed to evaluate long-term postoperative outcomes.

Low- and middle-income countries (LMICs) represent the highest incidence, morbidity, and Disability Adjusted Life Years for cleft lip and/or palate (CL/P) globally. Most cleft care models now include psychosocial support, yet the psychosocial impacts of CL/P in LMICs are understudied. This narrative review aimed to synthesize published literature to provide a foundation for future research and evidence-based psychosocial support. Seventy-one peer-reviewed articles published between September 2003 and July 2024 were included. Themes pertaining to caregivers included Social Experiences, Emotional Well-Being, Treatment Experiences, and overall Quality of Life. Themes regarding individuals with CL/P included Developmental Trajectory, Social Integration, Emotional Health, Satisfaction with Treatment, and Health-Related Quality of Life. Most articles focused on upper-middle-income countries. East Asia and Pacific was the most studied geographical region in LMICs, while Europe and Central Asia was the least studied. Only 28 of 135 LMICs (20.7%) were represented in the included psychosocial literature. Most studies (69%) utilized a quantitative design. Sample sizes ranged from 2 to 295, with 73% of studies recruiting from a single site. Few studies (28%) compared their data to reference or control groups. Just over half of studies used standardized, validated measures. Most studies were led by LMIC teams. This review calls for ongoing monitoring of psychological health in individuals with CL/P and their caregivers and coordinated investment into multifaceted psychosocial program in LMICs. Building practice-relevant research capacity in LMICs to develop the evidence-base is essential.

The ongoing COVID-19 outbreak has created obstacles to health care delivery on a global scale. Low- and middle-income countries (LMICs), many of which already suffered from unmet surgical and medical needs, are at great risk of suffering poor health outcomes due to health care access troubles brought on by the pandemic. Craniofacial outreach programs (CFOP)—a staple for craniofacial surgeons—have historically provided essential care to LMICs. To date, there has not been literature discussing the process of resuming CFOP mission trips. Herein, we propose a roadmap to help guide future journeys, as well as summarize practical considerations.

Objective: A protruded premaxilla has always been challenging to care for by cleft care professionals. This study aims to fortify the use of a single-stage premaxillary setback, with posterior vomerine ostectomy and primary cheiloplasty to achieve proper care for patients with bilateral cleft lip and palate (BCLP) and protruded premaxilla. Design: Longitudinal retrospective analysis. Setting: Twenty-three outreach programs to four countries (Ecuador, Lebanon, Peru, and El-Salvador) between 2016-2022. Patients/Participants: Sixty-five patients between the ages of 3 months and 6 years and 5 months, with BCLP and severely protruded premaxilla underwent premaxillary setback via posterior vomerine ostectomy and primary cheiloplasty. Patients with diagnosed syndromes and inaccessible vomer bone due to fused palates were excluded from the study. Interventions: Premaxillary setback with posterior vomerine ostectomy, bilateral gingivoperiosteoplasties (GPP), and primary cheiloplasty. Main Outcome Measure(s): Postoperative complications and aesthetic outcomes. Results: The mean age at surgery was 13.17 ± 14.1 months, with an average follow-up time of 26 ± 17 months. Patients underwent their procedures in Ecuador (72%), Peru (9%), Lebanon (8%) and El-Salvador (1%). The majority of patients were aged 1 year or less (66.7%) and were males (58.5%). All patients were operated on successfully and had good aesthetic outcomes. Only one patient developed partial necrosis. Conclusion: Patients with BCLP and severe premaxillary protrusion have always carried immense social, psychological, and financial burdens, especially in outreach settings. Our described single-stage technique has proven to be safe and effective with good aesthetic results. Further follow-up after primary repair should be done to document and ensure proper facial growth and normal nasolabial maturation.

Introduction: Postoperative feeding is crucial for the recovery of children after cleft surgery. The literature outlines diverse feeding methods with varying recommendations on the duration of non-nipple feeding postsurgery. This study aims to explore reported postoperative feeding modalities for infants undergoing primary cleft lip/palate repair, concentrating on their influence on feeding improvement and complication reduction. Methods: PubMed, Cochrane, and Web of Science databases were queried for original English articles without any date restrictions. This review was conducted in accordance with the 2020 PRISMA. The MINORS criteria was used to assess quality of studies. Results: Of 696 abstracts, 9 full-text articles were included, consisting of 459 children with cleft lip (n = 221) & cleft lip/palate (n = 238). Feeding modalities included bottle, breastfeeding, spoon, syringe, and nasogastric tube. Two studies found a significant increase in weight with breastfeeding compared to spoon or cup. Two studies found partial wound dehiscence using spoons, and two studies reported dehiscence using bottles. Post-palatoplasty, two studies showed a decrease in hospital stay in infants breastfed (2.1 & 5.8 days) vs spoon-fed (6 days). Analgesia was reduced in the breastfed group vs spoon/nasogastric tube. Conclusion: This review highlights the importance of postoperative feeding in the recovery of infants with cleft lip/palate. Evidence suggests that breastfeeding may offer advantages in terms of weight gain and reduced hospital stay, while potentially minimizing the need for postoperative analgesia. The limited number of studies and variability in their outcomes underscore the need for further research to establish evidence-based guidelines for postoperative feeding.

Velopharyngeal insufficiency (VPI) predominantly affects children with cleft palate, undermining their ability to communicate. As a result, intelligible speech generation is one of the most important outcomes following cleft palate repair. In low- and middle-income countries (LMICs), the elevated incidence of cleft palate, unavailability of speech services, and suboptimal surgical outcomes has contributed to a substantial yet poorly defined global burden of VPI. Tracking speech outcomes in LMICs is essential to assessing VPI severity and identifying patients needing care. Artificial intelligence and machine learning are well-suited to accommodate this goal.