Surgical Techniques for Cleft Lip Repair: Insights From Latin America and the Caribbean.

Abstract

Background: Cleft lip (CL) repair techniques vary significantly, often depending on surgeons' experience, preference, and cleft characteristics. In Latin America and the Caribbean (LAC), where CL prevalence is high, research on surgical practices remains limited. This study aims to document and analyze preferences for unilateral (UCL) and bilateral cleft lip (BCL) repair among Operation Smile surgeons in LAC to support improved cleft care.

Methods: A 22-question survey was distributed anonymously electronically to credentialed LAC surgeons performing UCL and BCL repairs. The survey explored demographics, preferred repair techniques, and surgical approaches such as nasal floor closure, gingivoperiosteoplasty, and setback techniques. Responses were analyzed using descriptive and inferential statistics.

Results: A total of 101 surgeons from 13 countries participated, with Peru (20%) having the highest representation. Most respondents were male (71%), with 36% having less than 5 years of experience. The Fisher technique was the most preferred method for UCL (66%) and BCL (29%), particularly among less experienced surgeons. Technique preferences varied significantly by country (P < 0.001). For UCL, most surgeons (78%) closed the nasal floor by joining septal and lateral mucosa, and 50% performed gingivoperiosteoplasty. For BCL, 58% used labial adhesion for maxillary protrusion, and 24% performed premaxillary setbacks, both varying significantly by experience and technique (P < 0.001).

Conclusions: This study reveals substantial variability in cleft repair techniques across LAC, with the Fisher technique emerging as a dominant preference. These findings provide a foundation for future research focusing on outcomes and complications to optimize cleft care in the region.