Dentist № 1 (60) – 2026, pp. 8-19                                                                                                                        MAXILLOFACIAL SURGERY

Clinical algorithm for the surgical stage of multidisciplinary rehabilitation of children with cleft lip and palate

D.A. Hrichaniuk

MD, PhD, Associate professor, Belarusian State Medical University, Minsk, Belarus

https://doi.org/10.32993/dentist.2026.1(60).4

ABSTRACT
Timely and technically sound surgical treatment methods are the foundation of age-specific comprehensive rehabilitation for children with this condition. Disunity among specialists, failure to adhere to optimal surgical windows, heterogeneity of surgical techniques, and a lack of a clear understanding of the treatment roadmap for families create challenges in organizing care and highlight the need for algorithmization. An ineffective, prolonged, or unsuccessful initial surgical stage leads to an unprofitable long-term economic burden on the healthcare system.
The aim of the study. To develop and substantiate a clinical algorithm for the surgical stage of multidisciplinary rehabilitation of children with cleft lip and palate.
Objects and methods. A prospective cohort comparative study of patients was conducted between 2010 and 2025. 600 children with various forms of congenital clefts of the upper lip and/or palate were examined and treated. Inclusion criteria included the presence of an isolated or complete typical cleft (ages 0 to 18 years) and informed parental consent. Exclusion criteria included syndromic forms of clefts, atypical facial clefts, and severe concomitant somatic pathology.
Results and discussion. During the study, a clinical algorithm for comprehensive, staged rehabilitation was developed and implemented. Key rehabilitation components included: staged approach, multidisciplinary approach, surgical protocol, criteria for transition to surgical treatment, and monitoring. Clinical and functional indicators, anthropometric and radiographic data, time indicators, and parental questionnaires were used to evaluate the effectiveness of the results.
Conclusion.  The developed algorithm makes it possible not only to improve the anatomical and functional results in a particular child, but also to increase the overall efficiency of the healthcare system, reducing the medical, social and economic consequences of this pathology.

Keywords: cleft lip, cleft palate, surgical treatment stagesy

References

  1. Ageeva M.I. Vozmozhnosti vnutriutrobnoj diagnostiki patologii lica [Possibilities of intrauterine diagnostics of facial pathology]. Materialy 2-j Vserossijskoj nauchno-prakticheskoj konferencii. – Proceedings of the 2nd All-Russian scientific and practical conference. M. 2006, pp. 9-12.
  2. Vissarionov S.V., CHudin A.V., Lando A.I. Osobennosti hirurgicheskogo lecheniya detej s vrozhdennymi rasshchelinami neba s ispol’zovaniem radiovolnovogo skal’pelya [Features of surgical treatment of children with congenital cleft palate using a radio wave scalpel]. CHelyustno-licevaya hirurgiya. – Maxillofacial surgery. 2018, T. 22, no 4, pp. 32-37.
  3. Grichanyuk D.A. Obogashchennaya trombocitami plazma krovi v hirurgicheskom lechenii vrozhdennyh rasshchelin verhnej guby i neba [Platelet-rich blood plasma in surgical treatment of congenital clefts of the upper lip and palate]. Sovrem. stomatologiya. – Modern dentistry. 2006, no 2, pp. 43–48.
  4. Grichanyuk D.A., Dubrovskaya I.I., Lishtvan L.M. Ekhograficheskoe issledovanie kak metod prenatal’noj i postnatal’noj diagnostiki pri porokah razvitiya chelyustno-licevoj oblasti [Echographic examination as a method of prenatal and postnatal diagnostics of malformations of the maxillofacial region]. Med. panorama. 2007, no 2, pp. 63–67.
  5. Grichanyuk D.A., CHujkin S.V., Davletshin N.A., Makusheva N.V. Hirurgicheskoe lechenie vrozhdennyh rasshchelin verhnej guby u detej [Surgical treatment of congenital clefts of the upper lip in children]. Problemy stomatologii. – Problems of Dentistry. 2018, no 1, pp. 40-46.
  6. Grichanyuk D.A. Vrozhdennaya odnostoronnyaya rasshchelina verhnej guby: tekhnika i principy hirurgicheskogo lecheniya [Congenital unilateral cleft lip: technique and principles of surgical treatment]. Hirurgiya “Vostochnaya Evropa”. – Surgery “Eastern Europe”. 2018, Tom 7, no 1, pp. 44-54.
  7. Davydov B.N. Anomalii i deformacii licevogo skeleta u bol’nyh s rasshchelinami verhnej guby i neba. [Anomalies and deformations of the facial skeleton in patients with cleft lip and palate]. N RIO TGMA, Tver. 1999, 104 p.
  8. Karapetyan I.S., Tarasenko S.V., Rogova I.V. Mul’tidisciplinarnyj podhod k reabilitacii detej s vrozhdennymi chelyustno-licevoj patologiej: organizaciya raboty centra [Multidisciplinary approach to the rehabilitation of children with congenital maxillofacial pathology: organization of the center’s work]. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. – Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation. 2020, T. 10, no 3, pp. 125-135.
  9. Korzhenevich E.I., Ruman G.M., Artyushkevich A.S., Grichanyuk D.A., Kolyadich ZH.V. Funkcional’naya rinoseptumplastika pri korrekcii deformacii naruzhnogo nosa v sochetanii s vrozhdennoj rasshchelinoj verhnej guby i neba [Functional rhinoseptumplasty in the correction of external nose deformity in combination with congenital cleft lip and palate]. Otorinolaringologiya “Vostochnaya Evropa”. – Otolaryngology “Eastern Europe”. 2017, Tom.7, no 3, pp. 316-318.
  10. Lazyuk G.I., Pribushenya O.V. Prenatal’naya diagnostika, kak naibolee effektivnyj metod profilaktiki nasledstvennoj patologii [Prenatal diagnostics as the most effective method of preventing hereditary pathology]. Materialy 8-go s”ezda genetikov i selekcionerov Respubliki Belarus’. – Proceedings of the 8th Congress of Geneticists and Breeders of the Republic of Belarus. Minsk. 2002, pp. 308-309.
  11. Ahuja R.B. Primary definitive nasal correction in patients presenting for late unilateral cleft lip repair. Plast ReconstrSurg. 2002, 110(1), pp. 17–24.
  12. Gatti G.L., Freda N., Giacomina A., Montemagni M., Sisti A. Cleft Lip and Palate Repair. J Craniofac Surg. 2017, V. 28 (8), pp. 1918-1924.
  13. John G. Meara. Unilateral Cleft Lip and Nasal Repair: techniques and principles. Iran J. Pediatr. 2011, vol. 21, no 2, pp. 129-138.
  14. Fisher D.M., Tse R., Marcus J.R. Objective measurements for grading the primary unilateral cleft lip nasal deformity. Plast Reconstr Surg. 2008, V. 122, pp. 874–880.
  15. Millard D.R., Latham R., Huifen X., Spiro S., Morovic C. Cleft lip and palate treated by presurgical orthopedics, gingivoperiosteoplasty, and lip adhesion (POPLA) compared with previous lip adhesion method: a preliminary study of serial dental casts. Plast Reconstr Surg. 1999, V. 103, pp. 1630-1644.
  16. Randall P. A triangular flap operation for the primary repair of unilateral clefts of the lip. Deformiti. PlastReconstr Surg. 1959, V. 23(4), pp. 331-47.
  17. Skoog T. A design for the repair of the unilateral cleft lips. Amer J Surg. 1958, V. 95(2), pp. 223-6.
  18. Tanikawa D.Y., Alonso N., Rocha D.L. Evaluation of primary cleft nose repair: severity of the cleft versus final position of the nose. J Craniofac Surg. 2010, V. 21, pp. 1519–1524.
  19. Tennison C.W. The repair of the unilateral cleft lip by the stencil method. Plast Reconstr Surg. 1952, V. 9(2), pp. 115-20.

Correspondence to:  E-mail: dr_gda@mail.ru