Kids who have had surgery for cleft lip/palate seem to have less visible scars than those done a generation ago.
How exactly have surgery methods improved?
In: 1809
Surgeon:
So pretty much every answer here is mostly wrong albeit well intentioned.
1. Technique hasn’t changed in decades. We use the same flap options.
2. Sutures have modestly changed, but not really, and that’s not really a factor here.
3. Da vinci and robot surgery is not a factor here at all, yet.
Timing has changed, but again, this has gone through phases/fads and gone back and forth since the 80s. It’s a push vs pull of speech pathology wanting to allow for speech development (earlier surgery) vs surgeons wanting to wait for skeletal growth.
In general, I’d say scar and outcomes haven’t improved since probably the 90s. They were as good then in the right hands.
Factors that improved outcomes are as follows:
1. Most importantly, the formation of craniofacial teams. Instead of just a surgeon, care is now covered by a multidisciplinary team including specially trained surgeons, maxillofacial surgeon for orthognathic surgery, ENT, orthodontist, dentist, psychologist, speech pathologists, etc. It all makes a difference, even the physical therapy from speech pathology and the phases of orthodontics (braces) change soft tissue outcomes and modify growth. We have a better handle on growth modification than we used to. Braces in general have made massive advances. Cleft surgery is a phases process from 10 weeks old to 17 years old. It’s effectively organized and planned now with individual best suited specialists at each important phase.
2. Better wound care: advanced collagens, PRP, etc
3. You are more likely to have a fellowship trained craniofacial surgeon now, rather than someone who also does clefts. Plastics, ENT, and OMFS all have fellowships now for this, and it’s very competitive. It also sounds sexy and rewarding, so we have about 3 craniofacial surgeons for every cleft patient in the US lol.
Graft material has changed. We have BMP and advanced allografts for palatal grafts now, but autogenous is still the gold standard as it has been for many decades.
The surgery itself really hasn’t changed.
https://plasticsurgerykey.com/a-history-of-cleft-lip-and-cleft-palate-surgery/
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