Oral Surgery, Otolaryngology, and Public Health Synergies in Cleft Lip and Palate Management: Effects on Patient Quality of Life
Keywords:
N\AAbstract
Background: Cleft lip and palate (CLP) represents one of the most prevalent congenital anomalies worldwide, affecting approximately one in 700 live births. Although surgical repair is the cornerstone of management, optimal outcomes depend on coordinated multidisciplinary care. Oral surgeons restore anatomy, otolaryngologists manage hearing and airway complications, and public health professionals address speech therapy, nutrition, and social integration. However, fragmented care can leave patients with residual functional and psychosocial challenges.
Objective: To assess the impact of integrated oral surgery, otolaryngology, and public health interventions on patient quality of life (QoL) in children with CLP.
Methods: A prospective cross-sectional study was conducted on 150 children (ages 5–18 years) with repaired CLP across two tertiary cleft centers between 2020 and 2023. Patients were divided into two groups: integrated care (oral surgery + otolaryngology + public health services) and fragmented care (uncoordinated or sequential specialty involvement). Data were collected on demographics, clinical outcomes (speech clarity, hearing, ENT interventions, surgical history), and access to public health services (speech therapy, family counseling). Quality of life was measured using the validated Cleft-Q instrument, covering speech, psychosocial, and social domains.
Results: Integrated care significantly improved QoL outcomes. Mean overall QoL was higher in Group A (84.5 ± 6.3) compared with Group B (72.1 ± 8.9, p<0.01). Speech-related QoL showed the greatest difference (88.2 vs. 70.6, p<0.01). ENT involvement reduced recurrent ear infections (18% vs. 32%, p=0.03) and improved hearing normalization (76% vs. 59%, p=0.02). Public health support, particularly early speech therapy, was independently associated with higher psychosocial QoL (p<0.05).
Conclusion: Coordinated multidisciplinary care, integrating oral surgery, otolaryngology, and public health, leads to significantly improved functional and psychosocial outcomes for CLP patients. Structured cleft teams and enhanced public health access should be prioritized globally to optimize patient quality of life
Downloads
References
Mossey P, Little J. Epidemiology of oral clefts: an international perspective. Front Oral Biol. 2009;14:1–18.
Wehby GL, Cassell CH. The impact of orofacial clefts on quality of life and healthcare use. Annu Rev Public Health. 2010;31:341–358.
Berkowitz S. Cleft Lip and Palate: Diagnosis and Management. Springer; 2013.
Sell D, Mildinhall S, Albery L, Wills AK, Sandy JR, Ness AR. The Cleft Care UK study. Part 4: Speech outcomes. Orthod Craniofac Res. 2015;18 Suppl 2:36–46.
Peterson-Falzone SJ, Hardin-Jones MA, Karnell MP. Cleft Palate Speech. Mosby; 2001.
Long RE Jr, Hathaway R, Daskalogiannakis J, et al. The role of otolaryngologists in cleft care. Laryngoscope. 2007;117(3):414–418.
Antonarakis GS, Tompson B. Oral health-related quality of life in children with cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2016;53(6):658–668.
Kramer FJ, Gruber R, Fialka F, Sinikovic B. Quality of life in children and adolescents with cleft lip and palate. J Craniofac Surg. 2009;20(6):2061–2066.
Alperovich M, Vyas RM, Staffenberg DA. Cleft lip and palate. Clin Plast Surg. 2014;41(2):165–179.
World Health Organization. Global strategies to reduce the health-care burden of craniofacial anomalies. WHO; 2002.
American Cleft Palate-Craniofacial Association. Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies. ACPA; 2018.
Shaw WC, Semb G, Nelson P, Brattström V, Molsted K, Prahl-Andersen B. The Eurocleft study. Cleft Palate Craniofac J. 2001;38(6):525–531.
Stock NM, Hammond V, Russell J, et al. Psychological adjustment in children with cleft lip and/or palate: a systematic review. Child Care Health Dev. 2015;41(3):354–375.
Nelson P, Glenny AM, Kirk S, Caress AL. Parents’ experiences of caring for a child with a cleft lip and/or palate. Child Care Health Dev. 2012;38(1):6–20.
Klassen AF, Tsangaris E, Forrest CR, et al. Quality of life of children treated for cleft lip and/or palate: a systematic review. Cleft Palate Craniofac J. 2012;49(4):435–443.
Sinko K, Jagsch R, Prechtl V, Watzinger F, Hollmann K, Baumann A. Evaluation of esthetic, functional, and quality-of-life outcome in cleft lip and palate patients. Cleft Palate Craniofac J. 2005;42(4):355–361.
Hunt O, Burden D, Hepper P, Johnston C. The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthod. 2005;27(3):274–285.
Reddy SG, Reddy RR, Bronkhorst EM, et al. Quality of life in patients with cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2013;50(3):237–246.
Persson M, Becker M, Svensson H. Quality of life in adults with repaired cleft lip and palate. Cleft Palate Craniofac J. 2012;49(4):406–413.
Flynn T, Mølsted K, Asher-McDade C, et al. Cleft lip and palate care in Europe: Clinical standards and outcomes. Eur J Orthod. 2012;34(3):324–329.
Broder HL, Wilson-Genderson M, Sischo L. Oral health-related quality of life in adolescents and young adults with cleft lip and palate. Cleft Palate Craniofac J. 2014;51(5):e1–e9.
de Aquino SN, Paranaíba LM, Martelli DR, et al. Oral health-related quality of life in children and adolescents with cleft lip and palate: a case-control study. Cleft Palate Craniofac J. 2015;52(6):651–656.
Stock NM, Feragen KB. Psychological adjustment of children and adolescents with cleft lip and palate: a systematic review. Dev Med Child Neurol. 2016;58(11):1108–1115.
Phua YS, de Chalain T. Incidence of oronasal fistulae and velopharyngeal insufficiency after cleft palate repair. Plast Reconstr Surg. 2008;122(2):295–301.
Sell D, Southby L, Wills AK, et al. Speech outcomes after cleft palate surgery: a UK multicenter study. Cleft Palate Craniofac J. 2017;54(6):681–690.
Fogh-Andersen P. Genetics and Cleft Lip and Palate. Springer; 1971.
Goodacre TE, Swan MC. Cleft lip and palate: current management. Paediatr Child Health. 2008;18(6):283–292.
Berk NW, Marazita ML. The role of psychosocial factors in cleft lip and palate. Cleft Palate Craniofac J. 2002;39(6):597–603.
World Health Organization. Meeting report on global strategies for the care of cleft lip and palate. WHO; 2011.
Allori AC, Mulliken JB, Meara JG, Shusterman S, Marcus JR. Classification of cleft lip/palate: Then and now. Cleft Palate Craniofac J. 2017;54(2):175–188.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
