Donald R. Laub

Neonatal Anesthesia Neurotoxicity: A Review for Cleft and Craniofacial Surgeons

There is growing evidence that the commonly used anesthetic agents cause some degree of damage to the early developing brain. The animal evidence for anesthetic neurotoxicity is compelling. Numerous confounders in human research prevent researchers from drawing definitive conclusions about the degree of risk. For every surgery, it should be assessed whether the benefits of an early surgical procedure justify a potential but unquantifiable risk of neurotoxicity of anesthetic agents. The timing and number of surgeries in our treatment protocols may need to be reevaluated to account for these potential risks.

Primary Cleft Lip and Palate Repair in Assam, India: Does Preoperative Anthropometric Analysis Help Identify Patients With Increased Surgical Risk in a Clinically Prescreened Population?

Objective To compare anthropometric z-scores with incidence of post-operative complications for patients undergoing primary cleft lip or palate repair. Design This was a retrospective observational analysis of patients from a surgical center in Assam, India, and includes a cohort from a single surgical mission completed before the opening of the center. Setting Patients included in the study underwent surgery during an Operation Smile mission before the opening of Operation Smiles Guwahati Comprehensive Cleft Care Center in Guwahati, India. The remaining cohort received treatment at the center. All patients received preoperative assessment and screening; surgery; and postoperative care, education, and follow-up. Patients, Participants Our sample size included 1941 patients and consisted of all patients with complete information in the database who returned for follow-up after receiving primary cleft lip repair or primary cleft palate repair between January 2011 and April 2013. Interventions Preoperative anthropometric measurements. Main Outcome Measure(s) Postoperative complications. Results Anthropometric z-scores were not a significant predictor of adverse surgical outcomes in the group analyzed. Palate surgery had increased risk of complication versus lip repair, with an overall odds ratio of 5.66 (P < .001) for all patients aged 3 to 228 months. Conclusions Anthropometric z-scores were not correlated with increased risk of surgical complications, possibly because patients were well screened for malnutrition before surgery at this center. Primary palate repair is associated with an approximate fivefold increased risk of developing postoperative complication(s) compared with primary lip repair.

Surgical Techniques for Treatment of Unilateral Cleft Lip

A surgeon intending habilitation of a child with cleft lip should be familiar with the nor‐ mal anatomy of the lip and nose, the distortions introduced by the cleft deformity, and the many techniques available to employ those best suited to correction of that child’s deformity.