Objectives and potential of follow-up care for patients with congenital orofacial clefts complicated by associated congenital malformations

Relevance. Follow-up care, as a systematic approach integrating therapeutic, diagnostic, and rehabilitative measures for patients with congenital orofacial clefts (OFC) in combination with congenital malformations (CM) of other organs and systems, is continuously evolving to improve patient outcomes.

Objective. To enhance the rehabilitation outcomes of children with OFC and associated CM by implementing innovations in follow-up care and treatment strategies.

Materials and methods. The study was conducted at the Bonum Multidisciplinary Clinical Medical Center (Yekaterinburg). Medical records of 2,475 patients with congenital OFC over a 25-year period (1998–2022) were analyzed. In 823 cases (33.25%), OFC was associated with CM of other organs and systems. The analysis of medical records for these 823 patients included an assessment of the perinatal history of the newborn and the mother, inpatient treatment records, and the timing of surgical interventions. Additionally, discharge summaries were reviewed to evaluate the effectiveness of a comprehensive, staged, multidisciplinary approach to care.

Results. The study identified the distribution of congenital orofacial clefts and associated CM among the 823 patients. The timing of primary cleft repair surgeries was analyzed, considering the presence of associated CM. The early and late postoperative periods were managed in accordance with a structured methodological algorithm for comprehensive restorative treatment, ensuring the sequential correction of primary and associated malformations. The effectiveness of the proposed approach to comprehensive preparation and surgical management was confirmed by a low rate of postoperative complications. Associated CM of other organs and systems were treated electively by specialized professionals from regional pediatric rehabilitation centers within the Bonum structure. Their interventions were coordinated through multidisciplinary case conferences at all stages of high-tech medical care.

Conclusions. The proposed strategy for follow-up care of patients with congenital OFC complicated by associated CM allowed for the systematization of therapeutic and rehabilitative measures, optimization of the timing, methods, and extent of primary surgical interventions, and improvement of specialized care outcomes for this patient population.

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