Regional variations in cleft lip and palate repair techniques: A mixed-methods study of international volunteer surgeons.

Abstract

Despite the availability of multitudes of surgical techniques for cleft lip and/or palate (CLP) repair, the geographic distribution of their usage remains largely unknown. We investigated the technical preferences in CLP repair within an international cohort of volunteer surgeons. This was a mixed-methods study. A retrospective review of patients with CLP treated within the Operation Smile programs between 2021-2024 was conducted. Clinical records were reviewed for operative techniques. Surgeons who did not specify their technique were then surveyed to elicit specific preferences. In total, 888 patients with CLP were included. Among them, 375 underwent primary unilateral cleft lip (UCL) repair (42.2%), 102 bilateral cleft lip (BCL) repair (11.5%), and 411 cleft palate (CP) repair (46.3%). The most frequently performed surgical techniques were the Fisher repair for UCL, Mulliken repair for BCL, and Bardach for CP. Regarding UCL and BCL techniques, no significant differences in preference were found between high-income country (HIC) and low-and middle-income country (LMIC) surgeons. For CP repair, the von Langenbeck technique was preferred by LMIC surgeons (44.7%), whereas the Bardach technique was preferred by HIC surgeons (57.6%) (p = 0.03). Novel modifications were reported 3 times for UCL repair, 7 times for BCL repair, and once for CP repair. Our study was the first to document the global variations in CLP techniques. Most HIC and LMIC surgeons prefer the Fisher repair for UCL. For CP repair, the HIC surgeons prefer the Bardach technique, while LMIC surgeons prefer the von Langenbeck technique. A concerted effort to transmit knowledge across borders is essential for continued technical innovation.