Targeting Surgeons' Decision-Making for Cleft Lip Surgery

The standard-of-care to evaluate patients for lip revision surgery relies on a subjective
assessment by the surgeon of the static face. The important role of function or movement
generally has been given far less consideration mainly because of the challenges faced by
surgeons (e.g., the amount/quality of the tissue available to alter movement). Presently,
even when surgeons do attempt to assess function, they do so in a subjective manner because
there are no quantitative/visual aids to incorporate functional assessment into their
treatment planning and decisions regarding lip surgery.

The Intervention approach proposed here has been refined sufficiently with surgeon feedback
to allow surgeons to broaden their "vista" of the patients' 'movement and form' problems.
Potentially, having identified a movement/form problem(s), surgeons could contemplate what
needs to be done to improve patient specific problem(s). Importantly, pilot studies
demonstrated that the Intervention had a definite impact on surgeons' decisions for lip
revision: Surgeons substantially, but variably, changed their problem list and treatment
planning goals. Thus, a goal of this study is to collect surgical outcome data which will be
used primarily to monitor adverse events but also will provide preliminary information on
improvement in patient outcomes (facial form and movement) when surgeons use the
Intervention. In addition, given that revision surgery is very common after the primary lip
repair, it is important to understand surgeons' decision-making with the use of the
Intervention, to determine surgeons' goals and expectations for primary lip repair surgery,
and to understand the surgical limitations that may lead to subsequent revision surgery.

Inclusion Criteria (Lip Revision):

- Age 4 to 21 years

- Presence of a previously repaired unilateral or bilateral cleft lip and palate with a
complete cleft of the primary palate and at least a partial or complete cleft of the
secondary palate

- The professional clinical recommendation by the craniofacial plastic surgeon for a
full or partial thickness lip revision

Exclusion Criteria (Lip Revision):

- Lip revision surgery within the past two years

- A diagnosis of a craniofacial anomaly other than cleft lip (and palate)

- A medical history of collagen vascular disease, or systemic neurologic impairment

- Mental, visual, or hearing impairment to the extent that comprehension or ability to
perform tests associated with the collection of the imaging data is hampered

Inclusion Criteria (Lip Repair)

- Age birth to 8 months

- Presence of an unrepaired unilateral or bilateral cleft lip and palate with a complete
cleft of the primary palate and at least a partial or complete cleft of the secondary
palate

Exclusion Criteria (Lip Repair)

- A diagnosis of a craniofacial anomaly other than cleft lip (and palate)

- A medical diagnosis of collagen vascular disease, and systemic neurologic impairment

- Mental, visual, or hearing impairment to the extent that the infant's ability to
perform tests associated with the collection of the imaging data is hampered