Experience of Field Cleft Surgery From 2 Nigerian Centers: A 10-year Review.

Background: There are several reports on field cleft surgery procedures, but none from a public health institution and a mission hospital. The experiences are highlighted to chronicle the methodology, scope, and outcomes of field surgery in these facilities. Methods: A retrospective review of 122 patients using data uploaded on the Smile Train Express database and the authors' personal records of field surgery was conducted from August 2010 to January 2020. Results: Ten outreaches (medical/surgical missions) were undertaken, and 122 patients were operated on. The ages ranged from 1 week to 55 years, with a male-to-female ratio of 1:0.8. The procedures ranged from lip revision to combined cheilo-palatoplasty. There were 95 unilateral lip and 14 bilateral lip repairs, 4 atypical cleft repairs, and 9 palatoplasties. One patient had a combined cheilo-palatoplasty. The commonest techniques performed were the Mohler modification of the Millard template for unilateral cheiloplasty, the Mulliken technique for bilateral cheiloplasty, and intravelar veloplasty for palatoplasty. Initially, no palatoplasty was done. The combination surgery was done in the ninth year. Adult cheiloplasty was done under local anesthesia, and conscious sedation was used for children. All palate repairs were done with total intravenous anesthesia using orotracheal intubation. Monitoring was done using pulse oximetry. There were no mortalities or blood transfusions. Complications included desaturation in 2 patients, requiring conversion to general anesthesia, postoperative bleeding (controlled by pressure), partial dehiscence, and palatal fistula formation (25%). Follow-up was up to 3 years. Conclusions: Field cleft surgery, including combined cheilo-palatoplasty with careful planning, proper patient selection, and careful surgery, is safe in Nigeria.