The rate of revision surgery for secondary deformities of the lip in cleft lip patients: A systematic review.

Abstract

Secondary deformities following primary cleft lip repair require varying degrees of surgical intervention, from minor scar revision to complete takedown and repair. Revision surgery can itself necessitate multiple interventions, representing a considerable burden for both patients and the health system. In this study, we evaluate the reported rates of revision surgery for secondary deformities of the lip within the literature. A systematic review was conducted following PRISMA criteria. Pubmed, SCOPUS, and Cochrane databases were utilized. Studies reporting rates of lip revision surgery were included. Studies with non-cleft patients, not in English, or those with primary and revision surgery at two different institutions were excluded. Thirty-four studies were included. The overall revision rate was 21.2±14.6% (Range: 0-91.2%). Stratified by phenotype, revision rates were 32.3±18.9% for isolated unilateral cleft lip, 78.6±6.5% for isolated bilateral cleft lip, 29.6±24.4% for unilateral cleft lip and palate, and 36.7±21.6% for bilateral cleft lip and palate. No significant differences were found between phenotypic groups. Revision rates did not significantly differ between studies that used presurgical orthopedics (16.6±13.6%) and those that did not (25.3±9.5%) (p=0.06). With regards to surgical technique, revision rates were 27.3±19.0% for rotation advancement, 12.0±22.4% for straight line repair, and 8.1±0.5% for anatomic subunit approximation (p=0.63). The most common surgical indication was scar revision (26.2%). Current literature reports a wide range of rates for revision surgery. The most common indication for secondary surgery is scar revision. Improved reporting of surgical technique is necessary to guide evidence-based protocols for primary lip repair.