Complications of cleft lip surgery

Most would agree that the ultimate aim of cleft surgery is that the patient look well, feed well, and speak well. To achieve these goals much attention has been paid in the literature to individual techniques of lip repair, to the clinical results of palatal surgery, to the speech end-product, and occasionally to problems associated with cleft palate surgery. However , little, if any, attention has been paid to the study of mortality and morbidity accompanying cleft lip operations. The present report attempts to determine the incidence of, and the apparent causative factors in, the complications of cleft lip surgery. The review covers some 585 cleft lip repairs (Figure 1) performed over a 15—year period, from 1950 through 1964 inclusive, at the Children's Hospital of the University of Pittsburgh. The procedures were all done by qualified plastic surgeons of the University's faculty or by residents under their direct supervision. The immediate operative results have been examined to form a baseline for comparison in the future, not only for ourselves but for others subjecting their cases to critical analysis. In addition, a search was made for factors whereby the operative results may be further improved. The various types of cleft lip pathology are shown in Figure 2. The morbidity and mortality figures to be presented obviously represent children who have survived to an operative age of at least 10 to 12 weeks, for in this particular medical center the cleft child is not rushed from the delivery room to the operating table. Such practice would seem to have a definite bearing on both the operative mortality and morbidity. Admittedly, tissues heal well in the newborn, but the child of but 24 hours of age has not yet gone through a 'shake—down cruise' and there has not been sufficient time for the pediatrician to determine accurately what other defects might be present. There is a quite definite incidence of death of the infant (admittedly the more severely involved ones) in the first few weeks of life. Fogh-Andersen (3) reported a mortality rate of these patients during early life (before operation) at about 15%. In