Evaluation of primary surgical outcomes in New Zealand patients with unilateral clefts of the lip and palate.

Abstract：

OBJECTIVE:To evaluate and compare the primary surgical outcomes of complete unilateral cleft lip and palate (UCLP) patients in two New Zealand cleft care centres. METHODS:This is a retrospective study of two providers of cleft care in New Zealand: Centre A in the North Island and Centre B in the South Island of New Zealand. Preorthodontic study models were evaluated from 28 UCLP patients from Centre A with primary surgical repairs performed between 1987-1999 and 31 UCLP patients from Centre B with primary surgical repairs performed between 1984-2000. Dental arch relationships were measured using the Goslon Yardstick. A Goslon score of 1 is considered to be an excellent outcome, whereas a score of 5 is a very poor treatment outcome. RESULTS:Intra- (Kappa: 0.84 - 0.93) and inter-examiner (Kappa: 0.63 - 0.69) reliabilities revealed good to very good agreement between examiners using the Goslon Yardstick. The mean Goslon score for Centre A was 3.5, with no cases in Group 1, five cases in Group 2 (17.9 per cent), nine cases in Group 3 (32.1 per cent), 11 cases in Group 4 (39.3 per cent) and three cases in Group 5 (10.7 per cent). The mean score for Centre B was 3.1, with one case in Group 1 (3.2 per cent), nine cases in Group 2 (29.0 per cent), eight cases in Group 3 (25.8 per cent), 11 cases in Group 4 (35.5 per cent) and two cases in Group 5 (6.5 per cent). There were no statistically significant differences between the two centres (p > 0.05). CONCLUSIONS:The outcome scores from the two cleft centres, based on historic records, were disappointing and higher than expected. It is recommended that a review of primary surgical protocols be implemented to ensure outcomes comparable with international standards. The results provide useful benchmarks for future comparisons of treatment.