Surgical Repair of Cleft Lip: Comparison of Neonatal and Standard Timing in a Systematic Review.

Cleft lip and palate (CLP) abnormalities are common birth defects encompassing isolated cleft lip, cleft palate, or combined CLP. Current knowledge indicates that CLP has both genetic and environmental causes, with strong associations between a positive family history and maternal factors such as smoking, alcohol consumption, teratogenic substance use, and poor nutrition. The upper lip develops as a result of the fusion of the paired medial nasal prominences to the maxillary prominences, forming the philtrum and lateral portions of the upper lip, respectively. Cleft lip, therefore, arises from a failure in those named structures to fuse. The current best treatment involves surgical repair to reconstruct the lip to restore normal appearance and function, including feeding and speech. This normally occurs around the age of six months (standard time) in most centers, but is performed much earlier, in the neonatal period, in other centers. This study aims to determine whether neonatal cleft lip repair is superior to standard time repair. Secondary aims are to determine both the feasibility and the safety of neonatal repair. Advanced literature searches were carried out using Medline ALL (1946 to date) and Embase (1974 to date); 11 articles were deemed relevant and included in this study. Aesthetic results showed excellent outcomes with neonatal repair with regard to the appearance of the scar, facial (lip and nasal) symmetry, but those aesthetic results are no better than those achieved at standard time. Although early intervention can be beneficial as early repair takes place when the cleft is less severe and when the tissues are more malleable, making the surgery less challenging, and when some aspects of fetal scar healing remain. Additionally, early repair has a positive impact on the development of the alveolar projections and can assist in reducing an alveolar cleft if present, improving the aesthetic outcome. Moreover, neonatal surgery carries with it no greater risk than surgery carried out at six months and will allow feeding to begin at an early stage, promoting recovery. Early repair also brings with it a large positive psychosocial impact, where infants and mothers can build a normal relationship from an early stage. Later in life, children and adults will be less self-conscious following good aesthetic repair. In conclusion, based on the limited available evidence, neonatal repair may be recommended over standard time repair.