Establishing cleft services in developing countries: Complications of cleft lip and palate surgery in rural areas of Indonesia

  • Ruslin, Muhammad (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University) ;
  • Dom, Lawrence (Department of Anesthesiology, Faculty of Medicine, Hasanuddin University) ;
  • Tajrin, Andi (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University) ;
  • Yusuf, Andi Sitti Hajrah (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hasanuddin University) ;
  • Arif, Syafri Kamsul (Department of Anesthesiology, Faculty of Medicine, Hasanuddin University) ;
  • Tanra, Andi Husni (Department of Anesthesiology, Faculty of Medicine, Hasanuddin University) ;
  • Ou, Keng Liang (School of Dentistry, College of Oral Medicine, Taipei Medical University) ;
  • Forouzanfar, Tymour (Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center) ;
  • Thamrin, Sri Astuti (Department of Statistics, Hasanuddin University)
  • 투고 : 2018.05.23
  • 심사 : 2019.07.31
  • 발행 : 2019.11.15


Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ2=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ2=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ2=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.



  1. Bicknell S, McFadden LR, Curran JB. Frequency of pharyngoplasty after primary repair of cleft palate. J Can Dent Assoc 2002;68:688-92.
  2. Acuna-Gonzalez G, Medina-Solis CE, Maupome G, et al. Family history and socioeconomic risk factors for non-syndromic cleft lip and palate: a matched case-control study in a less developed country. Biomedica 2011;31:381-91.
  3. Dixon MJ, Marazita ML, Beaty TH, et al. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet 2011;12:167-78.
  4. Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015;386:569-624.
  5. Nguyen C, Hernandez-Boussard T, Davies SM, et al. Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type. Cleft Palate Craniofac J 2014; 51:412-9.
  6. Conway JC, Taub PJ, Kling R, et al. Ten-year experience of more than 35,000 orofacial clefts in Africa. BMC Pediatr 2015;15:8.
  7. Willcox DS. Cleft palate rehabilitation: interim strategies in Indonesia. Cleft Palate Craniofac J 1994;31:316-20.
  8. Aziz SR, Rhee ST, Redai I. Cleft surgery in rural Bangladesh: reflections and experiences. J Oral Maxillofac Surg 2009;67:1581-8.
  9. Park TS, Bae YC, Nam SB, et al. Postoperative speech outcomes and complications in submucous cleft palate patients. Arch Plast Surg 2016;43:254-7.
  10. Cassell CH, Daniels J, Meyer RE. Timeliness of primary cleft lip/palate surgery. Cleft Palate Craniofac J 2009;46: 588-97.
  11. Schwarz R, Bhai Khadka S. Reasons for late presentation of cleft deformity in Nepal. Cleft Palate Craniofac J 2004;41: 199-201.
  12. Grimes CE, Bowman KG, Dodgion CM, et al. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 2011;35:941-50.
  13. Fillies T, Homann C, Meyer U, et al. Perioperative complications in infant cleft repair. Head Face Med 2007;3:9.
  14. Rossell-Perry P, Schneider WJ, Gavino-Gutierrez AM. A comparative study to evaluate a simple method for the management of postoperative bleeding following palatoplasty. Arch Plast Surg 2013;40:263-6.
  15. Jackson O, Basta M, Sonnad S, et al. Perioperative risk factors for adverse airway events in patients undergoing cleft palate repair. Cleft Palate Craniofac J 2013;50:330-6.
  16. Diah E, Lo LJ, Yun C, et al. Cleft oronasal fistula: a review of treatment results and a surgical management algorithm proposal. Chang Gung Med J 2007;30:529-37.
  17. Cohen M. Residual deformities after repair of clefts of the lip and palate. Clin Plast Surg 2004;31:331-45.

피인용 문헌

  1. Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia vol.58, pp.10, 2021,