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Cleft Care in International Adoption
Jesse Goldstein, MD1, Patrick Mason, MD2, Deniz Basci, BA3, Lora Hindenburg, RN2, Craig Dusfresne, MD2, Stephen Baker, MD, DDS1.
1Georgetown University, Washington, DC, USA, 2Inova Fairfax Hospital for Children, Fairfax, VA, USA, 3George Washington University, Washington, DC, USA.

BACKGROUND: Standards of cleft care in countries where international adoption rates are high often differ considerably from those in the United States. Children with cleft lip/palate deformities adopted from these countries present to plastic surgeons in the United States in various states of repair and often at ages well beyond accepted treatment norms. The operative and peri-operative needs of these children necessitating surgical intervention upon arrival in the United States are poorly understood.
Methods: We performed a long-term retrospective review of all adopted cleft lip/palate patients presenting to an academic craniofacial referral center. Pre-adoption medical records, craniofacial clinic charts/ACPA database, and operative reports were analyzed for demographic characteristics, pre-adoption history, post-adoption interventions, and outcomes.
Results: Between May, 1993 and August, 2010, 83 adopted children with cleft lip/cleft palate deformities were evaluated in our craniofacial center. Average age at adoption was 30.5 (range 5.0-95.0) months. Originating countries were predominantly China (78.4%), Russia (12.1%), and Ukraine (4.8%). Table 1 describes the diagnoses of our patient population. Pre-adoption medical records were available for 21.8% of patients. 76.4% (n=42) of unilateral cleft lip patients and 73.9% (n=17) of bilateral cleft lip patients were repaired prior to adoption at an average age of 10.8 months (range 5.4-15.5 months). 32.8% (n=22) of cleft palate patients were repaired prior to adoption at an average age of 25.6 (range 8.4-40.0) months. Table 2 describes the post-adoption procedures performed on our patient population. Average age of post-adoption primary repair was 17.8 (range 7.6-23.7) months for unilateral cleft lip deformities, 21.5 (range 8.4-40.0) months for bilateral cleft lip deformities, and 27.9 (range 10.5-85.9) months for cleft palate deformities. There were 6 (27.27%) clinically significant fistulas in patients who underwent pre-adoption palate repair compared to 8 (22.22%) in patients who underwent palate repair post-adoption (p=0.45). Hypernasal speech developed in 9 (40.91%) patients who underwent pre-adoption palate repair compared to 22 (61.11%) patients who underwent palate repair post-adoption (p=0.11), while velopharyngeal insufficiency was observed in 3 (13.64%) patients who underwent pre-adoption palate repair compared to 7 (19.44%) patients who underwent palate repair post-adoption (p=0.43). When assessing the quality of the lip repairs, 28 (47.46%) patients who underwent pre-adoption lip repair compared to 7 (41.18%) patients who underwent lip repair post-adoption (p=0.43) were deemed to have poor aesthetic results that would benefit from revision..
Conclusion: The adopted cleft patient represents a complex and variable population with high rates of revision and delayed presentation. Surgical outcomes are poor in these patients compared to non-adopted populations.
Diagnoses
DiagnosesNumberPercent
Isolated Cleft Lip1416.87
Isolated Cleft Palate33.61
Unilateral Cleft Lip/Palate4554.22
Bilateral Cleft Lip/Palate1922.89
Submucous Cleft22.41
TOTAL83100.00

Post-Adoption Procedures
Post-Adoption ProceduresNumberPercent
Primary Lip Repair
Unilateral
Bilateral
TOTAL
11
6
17
20.00
26.09
21.79
Lip revision on Pre-Adoption repairs
Unilateral
Bilateral
TOTAL
7
3
10
16.67
17.65
16.95
Lip revision on Post-Adoption repairs
Unilateral
Bilateral
TOTAL
3
0
3
27.27
0.00
17.65
Primary Palate Repair3653.73
Revision Palate Repair1014.93


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