The Burden of Cleft Surgery a 36-Year Reflection of Surgical Management of Children With Orofacial Clefts in South Australia

Objective To describe the timing of surgeries, characterize the number of surgical and anesthetic events, and describe the total number and timing of cleft-related and ancillary surgical procedures from birth to late adolescence, stratified by cleft subtype and syndrome status. Design Retrospective, cross-sectional clinical review of medical and surgical records. Setting A tertiary children's hospital with a dedicated Cleft and Craniofacial Surgical Unit in Adelaide, South Australia. Participants Children aged 0 to 18 years who underwent surgical intervention for orofacial clefts at the Women's and Children's Hospital between 1985 and 2021. Interventions Surgical management of orofacial clefts and ancillary procedures performed under general anesthesia (GA). Main Outcome Measure(s) Timing and number of cleft-related surgeries; total number of procedures performed under GA; comparisons by syndrome status and cleft subtype. Results A total of 746 children were included. The mean age at primary lip repair was 4.8 months, and palate repair was 18.4 months. Alveolar bone grafting was typically performed at a mean age of 129.4 months. Later procedures included lip/nasal revision and orthognathic surgery. The mean number of GA procedures per child was 3.9 (SD ± 3.3), significantly higher in syndromic children (mean 6.5, SD ± 5.3) than nonsyndromic children (mean 3.4, SD ± 2.3). Noncleft-related procedures, such as grommet insertion (45.6%) and dental treatment under GA (28.1%) added to the total surgical burden. Conclusions Children with orofacial clefts experience multiple surgical procedures throughout development, especially those with syndromic diagnoses. These findings reinforce the importance of long-term, multidisciplinary planning and provide data to guide cleft care protocols and family support.