Sarmad Jaafar Mohammed Alrubaye (1)
Background: Cleft lip and palate represent common congenital anomalies with substantial regional variation in presentation and management outcomes. Specific Background: In Kerbala, Iraq, comprehensive data on cleft phenotype distribution, surgical practices, and postoperative complications remain limited despite the condition's prevalence of approximately 1 per 1000 live births. Knowledge Gap: Existing literature lacks detailed regional profiles characterizing phenotype patterns, perioperative protocols, and complication rates specific to this population. Aims: This retrospective chart review examined 55 patients across three Kerbala hospitals to document cleft phenotype distribution, laterality, surgical management approaches, and postoperative outcomes. Results: Cleft lip and palate constituted the predominant phenotype (69.1%), with male predominance (54.55%) and unilateral presentation (67.3%) most common. Primary repairs utilized absorbable sutures with brief hospitalization (81.81% discharged within 1-2 days). Alveolar bone grafting occurred in 34.7% of cases. Postoperative complications included fistula formation (12.7%), scarring (27.2%), and dehiscence (18%), requiring revision surgery in 12.7% of patients. Novelty: This study provides the first comprehensive regional profile of cleft management in Kerbala, establishing baseline metrics for phenotype distribution and surgical outcomes. Implications: Findings highlight the necessity for standardized outcome tracking, enhanced multidisciplinary care protocols, and targeted interventions addressing persistent complications to optimize functional and aesthetic results in this population.Highlight :
Keywords : left Lip and Palate, Surgical Management, Postoperative Complications, Phenotype Distribution, Alveolar Bone Grafting
T. Bartzela, I. Hoffmann, J. Kluge, F. Jäger, M. Schmechel, and C. Opitz, "Timing Matters: Dental Development and Outcomes on Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients," Clin. Oral Investig., vol. 29, no. 11, pp. 1-15, 2025, doi: 10.1007/s00784-025-xxxxx.
W. Chetpakdeechit, P. Pisek, W. Pitiphat, and S. Rattanakanokchai, "Cleft Size and Success of Secondary Alveolar Bone Grafting—A Systematic Review," Cleft Palate Craniofac. J., vol. 60, no. 3, pp. 285-298, 2023, doi: 10.1177/10556656221089876.
R. Denadai and L.-J. Lo, Current Concept in Cleft Surgery: Moving Toward Excellence of Outcome and Reducing the Burden of Care. Cham, Switzerland: Springer Nature, 2022.
U. P. Egbunah, O. Adamson, A. Fashina, A. A. Adekunle, O. James, and W. L. Adeyemo, "Comparing the Treatment Outcomes of Absorbable Sutures, Nonabsorbable Sutures, and Tissue Adhesives in Cleft Lip Repair: A Systematic Review," Cleft Palate Craniofac. J., vol. 59, no. 1, pp. 110-120, 2022, doi: 10.1177/1055665621995353.
M. Fell, A. Davies, A. Davies, S. Chummun, A. R. Cobb, K. Moar, and Y. Wren, "Current Surgical Practice for Children Born with a Cleft Lip and/or Palate in the United Kingdom," Cleft Palate Craniofac. J., vol. 60, no. 6, pp. 679-688, 2023, doi: 10.1177/10556656221082445.
M. Hardin-Jones and K. L. Chapman, "The Impact of Early Intervention on Speech and Lexical Development for Toddlers with Cleft Palate: A Retrospective Look at Outcome," Lang. Speech Hear. Serv. Sch., vol. 39, no. 1, pp. 89-96, 2008, doi: 10.1044/0161-1461(2008/009).
E. A. Kadhim, "Incidence of Cleft Lip and Palate in Karbala Province," Indian J. Public Health Res. Dev., vol. 9, no. 10, pp. 579-583, 2018, doi: 10.5958/0976-5506.2018.01313.4.
C. Kennedy, S. Young, K. Davis, E. W. Creighton, A. Johnson, and L. Hartzell, "Evaluating Geographic Distribution and Potential Environmental Risk Factors of Orofacial Cleft Anomalies Utilizing a Statewide Birth Defects Registry," Cleft Palate Craniofac. J., 2025, doi: 10.1177/10556656251326443.
M. Kulesa-Mrowiecka, A. Lipowicz, B. A. Marszałek-Kruk, D. Kania, W. Wolański, A. Myśliwiec, and K. Dowgierd, "Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review," Children, vol. 11, no. 4, art. 399, 2024, doi: 10.3390/children11040399.
R. E. Long, M. Wilson-Genderson, B. H. Grayson, R. Flores, and H. L. Broder, "Oral Health–Related Quality of Life and Self-Rated Speech in Children with Existing Fistulas in Midchildhood and Adolescence," Cleft Palate Craniofac. J., vol. 53, no. 6, pp. 664-669, 2016, doi: 10.1597/15-138.
J. K. Moffitt, A. Cepeda Jr., R. A. Ekeoduru, J. F. Teichgraeber, P. D. Nguyen, and M. R. Greives, "Enhanced Recovery After Surgery Protocol for Primary Cleft Palate Repair: Improving Transition of Care," J. Craniofac. Surg., vol. 32, no. 1, pp. e72-e76, 2021, doi: 10.1097/SCS.0000000000006886.
L. S. Mundra, K. M. Lowe, and D. Y. Khechoyan, "Alveolar Bone Graft Timing in Patients with Cleft Lip & Palate," J. Craniofac. Surg., vol. 33, no. 1, pp. 206-210, 2022, doi: 10.1097/SCS.0000000000008083.
K. Muzammil, N. Nasir, A. Hassan, P. Padda, Z. Siddiqui, S. E. Mahmood, K. Zafar, and H. Abbas, "Epidemiological Aspects of Cleft Lip and Cleft Palate," J. Evol. Med. Dent. Sci., vol. 10, no. 36, pp. 3178-3183, 2021, doi: 10.14260/jemds/2021/649.
K. Oginawati, I. N. A. Rahman, N. Fahimah, R. J. Nathanael, I. O. Jatmy, T. I. Muhanandi, I. Latifah, A. Tajrin, I. Tanziha, and S. Silvia, "Residential Environment and Parental Lifestyle as Risk Factors of The Co-Occurrence of Cleft Lip and Palate Birth Defect Cases in Indonesia," J. Multidiscip. Appl. Nat. Sci., vol. 5, no. 1, pp. 103-118, 2025, doi: 10.47352/jmans.2774-3047.252.
A. K. Oh, K. Magge, T. M. Sauerhammer, J. Kim, M. Atnafu, M. J. Boyajian, and G. F. Rogers, "Clinical Factors Affecting Length of Stay After 100 Consecutive Cases of Primary Cleft Lip Repair," Cleft Palate Craniofac. J., vol. 52, no. 4, pp. 447-451, 2015, doi: 10.1597/13-324.
D. Papaefthymiou, D. M. Agrafioti, and H. N. Yilmaz, "Correlation of Dental Anomalies with Cleft Type and Gender in Non-Syndromic Oral Cleft Patients: A Cross-Sectional Study," Cleft Palate Craniofac. J., vol. 61, no. 2, pp. 284-294, 2024, doi: 10.1177/10556656221135689.
N. R. Paul and S. L. Rolland, "Characteristics of Orthognathic Multidisciplinary Team Clinics in England. Part 2: A Qualitative Study," J. Orthod., vol. 50, no. 3, pp. 296-302, 2023, doi: 10.1177/14653125231165324.
C. Ramzy, R. Gaber, and M. El Kassaby, "Dilemma of Postoperative Scarring in Cleft Lip and Palate: A Narrative Review," Egypt. J. Oral Maxillofac. Surg., vol. 14, no. 4, pp. 121-126, 2023, doi: 10.21608/ejoms.2023.xxxxxx.
R. Rullo, V. Festa, R. Rullo, F. Addabbo, P. Chiodini, M. Vitale, and L. Perillo, "Prevalence of Dental Anomalies in Children with Cleft Lip and Unilateral and Bilateral Cleft Lip and Palate," Eur. J. Paediatr. Dent., vol. 16, no. 3, pp. 229-232, 2015.
A. K. Sander, C. Muche-Borowski, and B. Lethaus, "Clinical Practice Guideline: The Treatment of Cleft Lip and Palate Deformities," Dtsch. Arztebl. Int., vol. 122, no. 12, pp. 328, 2025, doi: 10.3238/arztebl.m2025.0010.
N. M. Stock, D. Blaso, and M. Hotton, "Caring for a Child with a Cleft Lip and/or Palate: A Narrative Review," Cleft Palate Craniofac. J., vol. 62, no. 11, pp. 1947-1974, 2025, doi: 10.1177/10556656241234567.
M. Sutcu, C. Isık, A. Dogramaci, C. Irgın, O. Akdag, and Z. Tosun, "Early Postoperative Complications in Primary Cleft Lip and Palate Repair: A Retrospective Analysis of 328 Cases," J. Contemp. Med., vol. 11, no. 5, pp. 617-621, 2021, doi: 10.16899/jcm.963140.
T. Vyas, P. Gupta, S. Kumar, R. Gupta, T. Gupta, and H. P. Singh, "Cleft of Lip and Palate: A Review," J. Fam. Med. Prim. Care, vol. 9, no. 6, pp. 2621-2625, 2020, doi: 10.4103/jfmpc.jfmpc_472_20.
C. E. Zimmerman, N. Folsom, L. S. Humphries, C. L. Kalmar, G. H. Vu, J. Bushold, J. W. Swanson, and J. A. Taylor, "What Is the Impact of Prenatal Counseling on Postnatal Cleft Treatment? Multidisciplinary Pathway for Prenatal Orofacial Cleft Care," J. Craniofac. Surg., vol. 32, no. 3, pp. 947-951, 2021, doi: 10.1097/SCS.0000000000007217.