Use of Perioperative Antibiotics in Cleft Lip and Palate Surgery: A Systematic Review

Background: Orofacial clefts are the most common craniofacial birth defect and present significant functional and esthetic challenges. Surgical repair is essential, with prevention of complications, particularly infection, fistula, and dehiscence, being critical. The role of perioperative antibiotics in reducing these complications remains unclear, with conflicting evidence in the literature. This systematic review evaluates the effect of perioperative antibiotics on complication rates in cleft lip repair, palatoplasty, and alveolar bone grafting. Methods: Medline, Embase, EBM, and Web of Science were searched from 1995 to 2025. Eligible studies evaluated perioperative antibiotic use in cleft procedures and included a comparator group. Non-English studies and those lacking treatment outcomes were excluded. Results: Ten studies met inclusion criteria. Six investigated palatoplasty, 2 included cleft lip and palate repair, and 2 examined alveolar bone grafting. Considerable variability was noted in antibiotic regimen, timing, and outcome reporting. Across procedures, prophylactic or prolonged antibiotic use was not associated with reduced complications. In cleft lip repair, infection occurred in 4.2% (n = 3/72) with no reduction from antibiotics. In palatoplasty, fistula occurred in 8.2% (n = 283/3457) with no benefit of extended antibiotics. In alveolar bone grafting, graft loss occurred in 2.7% (n = 5/185) without advantage from prolonged use. Conclusions: Current evidence does not support perioperative antibiotics as effective in reducing infection, fistula, or graft loss in cleft surgery, however existing research quality is low. Standardized, high-quality comparative studies are needed to better define their role in perioperative management.