Actualidad del manejo interdisciplinario por otorrinolaringología, cirugía plástica y cirugía maxilofacial del labio leporino y la hendidura palatina en niños: una revisión sistemática

Abstract

This systematic review analyzes the current interdisciplinary management of cleft lip and palate in the pediatric population. The objective was to compare contemporary approaches implemented by plastic surgery, maxillofacial surgery, and otolaryngology, evaluating their impact on functional and aesthetic outcomes, as well as complication rates [1–5].

This systematic review analyzes the current interdisciplinary management of cleft lip and palate in the pediatric population. The objective was to compare contemporary approaches implemented by plastic surgery, maxillofacial surgery, and otolaryngology, evaluating their impact on functional and aesthetic outcomes, as well as complication rates [1–5].

Out of 772 identified articles, 100 were included in the final analysis. Extracted variables included type of intervention, protocol used, age at surgery, complications, reinterventions, multidisciplinary follow-up, and functional (speech, hearing) and aesthetic outcomes (symmetry, satisfaction) [8–10]. The average methodological quality score was 8.5/10 based on the CASP scale.The most frequent interventions were primary palatoplasty, cheiloplasty, early rhinoplasty, alveolar bone grafts, and early insertion of tympanostomy tubes [3,5,11–13]. Protocols such as Oslo and Furlow showed better overall outcomes [2,14–16]. Interventions performed before 12 months of age achieved lower incidence of velopharyngeal insufficiency (VPI), fewer fistulas, and greater speech intelligibility [10,12,17]. Active participation of interdisciplinary teams was associated with reduced complication rates and more effective clinical follow-up [4,18,19].

Aesthetic results were superior when nasoalveolar molding (NAM) and early rhinoplasties were used [9,20]. Reported complications included oronasal fistulas (up to 22%) [1,21], tube extrusion (15–20%) [11], and mucosal ulcers from orthodontic devices (12–18%) [32]. The need for reintervention was lower in standardized protocols and in centers with coordinated follow-up [3,14,33]

In conclusion, early, protocolized, and evidence-based interdisciplinary management allows for comprehensive improvement in the treatment of cleft lip and palate. International standardization, the use of objective assessment tools, and the integration of longitudinal follow-up are essential to optimize functional, aesthetic, and psychosocial outcomes [6,7,10]. This review highlights the need to strengthen collaborative multicenter research to harmonize practices and close care gaps, particularly in contexts with limited access to specialized teams.[24,25].