Clinical Practice Guideline: The Treatment of Cleft Lip and Palate Deformities.

Abstract

Background: Cleft lip and palate deformities (CLPD) constitute one of the more common types of congenital malformation. In Germany, the prevalence is more than 1 in 500 births. The treatment is complex; multistep interdisciplinary treatment is needed for full recovery. In this S3-level clinical practice guideline, we provide evidence- and consensus-based recommendations for the treatment of patients with CLPD.

Methods: A systematic literature search based on key questions was carried out. All recommendations and statements were formulated by specialists from multiple disciplines and were adopted in a formal consensus procedure.

Results: Despite the epidemiological and clinical importance of CLPD, no clear treatment recommendations are available; the major treatments for it are debated and variably provided. If a fetus is at elevated risk of CLPD, ultrasonography in the second or third trimester of pregnancy is recommended. For a newborn child with CLPD, adequate food intake must be ensured. Orthodontic treatment is carried out in an interdisciplinary manner and in multiple developmental phases. Controversy surrounds the timing and sequence of reconstructive procedures for defor mities that affect all structures. In children who have them, normal ventilation of the middle ear is impaired or obviated, making tympanic effusions and hearing loss more likely. In all children with CLPD, speech can be impaired and there can be a secondary impairment of language acquisition.

Conclusion: Most of the evidence concerning the treatment of CLPD is of low level. Standardization of the treatment approach should improve long-term outcomes and quality of life in patients with CLPD. Standardized, long-term, multicenter data acquisition would help increase the yield of useful information from future studies.