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Secondary surgery techniques to optimise functional and aesthetic outcomes in orofacial clefting

British Dental Journal volume 234, pages 899–905 (2023)Cite this article

Abstract

Although the goal of primary surgery is to avoid the need for secondary surgery, in a proportion of patients this is not always possible. Secondary, or revisional, surgery is frequently undertaken in patients with orofacial clefts and may present a complex and challenging problem for the multidisciplinary team. There are a broad range of functional and aesthetic issues that secondary surgery might aim to address. These include palatal fistulae (that may be symptomatic for air, fluid or food), velopharyngeal insufficiency (typically manifesting with decreased intelligibility or nasal regurgitation), suboptimal cleft lip scars (that can significantly impact upon the psychosocial wellbeing of the patient), and nasal asymmetry (that is frequently accompanied by nasal airway concerns). Unilateral and bilateral clefts are each associated with a characteristic nasal deformity that requires a tailored surgical approach. Suboptimal maxillary growth in repaired orofacial clefts may impact negatively on both appearance and function; surgical correction through orthognathic surgery can be transformational for the patient. The general dental practitioner, cleft orthodontist and restorative dentist all play a critical role in this process.

Key points

  • This paper provides an overview of secondary surgery techniques that are currently used to improve functional and aesthetic outcomes in patients with orofacial clefts.

  • These revisional procedures can be both complex and challenging, and may have a significant psychosocial impact on the patient, so they mandate a multidisciplinary approach.

  • A synopsis of secondary palatal surgery techiques including fistula repair and speech surgery, as well as the utility of orthognathic surgery in addressing maxillary hypoplasia.

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Authors and Affiliations

  1. Cleft Fellow, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom

    Serena V. Martin

  2. Consultant Cleft and Maxillofacial Surgeon, Alder Hey Children´s Hospital and Aintree University Hospital, Liverpool, L14 5AB, United Kingdom

    Simon Van Eeden

  3. Consultant Cleft and Plastic Surgeon, Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, United Kingdom

    Marc C. Swan

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  1. Serena V. Martin
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All three authors contributed to the concept, content and preparation of this manuscript.

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Correspondence to Marc C. Swan.

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The authors declare no conflicts of interest. Written consent to publish was obtained for Figures 10 and 11.

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Martin, S., Van Eeden, S. & Swan, M. Secondary surgery techniques to optimise functional and aesthetic outcomes in orofacial clefting. Br Dent J 234, 899–905 (2023). https://doi.org/10.1038/s41415-023-6001-8

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