{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:28:44Z","timestamp":1787729324809,"version":"build-2784847793"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The traditional approach in managing wide cleft lip deformities involves presurgical nasoalveolar molding (NAM) therapy followed by surgical cleft lip repair between three and six months of age. This institution has implemented an early cleft lip repair (ECLR) protocol where infants undergo primary cleft lip repair between two and five weeks of age without NAM. This study aims to present this institution\u2019s ECLR repair protocol over the past eight years from 188 consecutive patients with unilateral or bilateral CL\/P deformity. Materials and Methods: Retrospective review was conducted at Children\u2019s Hospital Los Angeles evaluating patients who underwent ECLR before three months of age and were classified as American Society of Anesthesiologists (ASA) class I or II from 2015\u20132022. Anthropometric analysis was performed, and pre- and postoperative photographs were evaluated to assess nasal and lip symmetry. Results: The average age at cleft lip repair after correcting for gestational age was 1.0 \u00b1 0.5 months. Mean operative and anesthetic times were 120.3 \u00b1 33.0 min and 189.4 \u00b1 35.4, respectively. Only 2.1% (4\/188) of patients had postoperative complications. Lip revision rates were 11.4% (20\/175) and 15.4% (2\/13) for unilateral and bilateral repairs, respectively, most of which were minor in severity (16\/22, 72.7%). Postoperative anthropometric measurements demonstrated significant improvements in nasal and lip symmetry (p &lt; 0.001). Conclusions: This analysis demonstrates the safety and efficacy of ECLR in correcting all unilateral cleft lip and nasal deformities of patients who were ASA classes I or II. At this institution, ECLR has minimized the need for NAM, which is now reserved for patients with bilateral cleft lip, late presentation, or comorbidities that preclude them from early repair. ECLR serves as a valuable option for patients with a wide range of cleft severity while reducing the burden of care.<\/jats:p>","DOI":"10.3390\/medicina59101741","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T05:55:54Z","timestamp":1695880554000},"page":"1741","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Lessons Learned from a Single Institution\u2019s Eight Years of Experience with Early Cleft Lip Repair"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7843-583X","authenticated-orcid":false,"given":"Idean","family":"Roohani","sequence":"first","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collean","family":"Trotter","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasha","family":"Shakoori","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayla A.","family":"Moshal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Lasky","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Manasyan","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"William P.","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Hammoudeh","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"},{"name":"Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data","volume":"13","author":"DeFrances","year":"2007","journal-title":"Vital Health Stat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/10556656211062042","article-title":"Rethinking the Rule of 10s: Early Cleft Lip Repair Improves Weight Gain","volume":"60","author":"Kondra","year":"2023","journal-title":"Cleft Palate Craniofac J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1097\/PRS.0000000000009634","article-title":"Early Cleft Lip Repair: Demonstrating Efficacy in the First 100 Patients","volume":"150","author":"Wlodarczyk","year":"2022","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1340","DOI":"10.1097\/GOX.0000000000001340","article-title":"Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol","volume":"5","author":"Hammoudeh","year":"2017","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_5","first-page":"79","article-title":"Timing of cleft lip and palate repair","volume":"18","author":"Kobus","year":"2014","journal-title":"Dev. Period Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1097\/PRS.0000000000000721","article-title":"Evidence-based medicine: Unilateral cleft lip and nose repair","volume":"134","author":"Greives","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1097\/PRS.0000000000002476","article-title":"Evaluating the Rule of 10s in Cleft Lip Repair: Do Data Support Dogma?","volume":"138","author":"Chow","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","first-page":"223","article-title":"Complications of cleft lip surgery","volume":"3","author":"Wilhelmsen","year":"1966","journal-title":"Cleft Palate J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/0007-1226(93)90117-T","article-title":"Early repair of unilateral cleft lip employing a small triangular flap method and primary nasal correction","volume":"46","author":"Nakajima","year":"1993","journal-title":"Br. J. Plast. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1016\/j.ijporl.2006.06.004","article-title":"Early repair for infants with cleft lip and nose","volume":"70","author":"Mcheik","year":"2006","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1097\/00006534-198706000-00004","article-title":"Early repair and breast-feeding for infants with cleft lip","volume":"79","author":"Kuehn","year":"1987","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1002\/uog.6447","article-title":"Antenatal detection of cleft lip with or without cleft palate: Incidence of associated chromosomal and structural anomalies","volume":"34","author":"Gillham","year":"2009","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_13","unstructured":"(2023, August 22). U.S. Infant Mortality Rate 1950\u20132023 n.d, Available online: https:\/\/www.macrotrends.net\/countries\/USA\/united-states\/infant-mortality-rate."},{"key":"ref_14","first-page":"358","article-title":"Nonsurgical correction of cleft lip nasal deformity in the early neonate","volume":"17","author":"Matsuo","year":"1988","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/014107689208500219","article-title":"Neonatal cleft lip repair","volume":"85","author":"Erdmann","year":"1992","journal-title":"J. R. Soc. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1056\/NEJM196709142771107","article-title":"Unilateral cleft lip","volume":"277","author":"Cannon","year":"1967","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/00000637-198303000-00007","article-title":"Cleft lip: Morbidity and mortality in early repair","volume":"10","author":"Bromley","year":"1983","journal-title":"Ann. Plast. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3109\/02844311.2010.499666","article-title":"Safety of neonatal cleft lip repair","volume":"44","author":"Harris","year":"2010","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1016\/j.bjps.2009.10.033","article-title":"Combined early cleft lip and palate repair in children under 10 months\u2014A series of 106 patients","volume":"63","author":"Hodges","year":"2010","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1097\/PRS.0b013e3181e617bb","article-title":"Ear molding in newborn infants with auricular deformities","volume":"126","author":"Byrd","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1001\/archotol.1961.00740020047005","article-title":"The effect of intravenous estrogens on ground substance","volume":"73","author":"Schiff","year":"1961","journal-title":"Arch. Otolaryngol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1203\/00006450-197310000-00006","article-title":"Unconjugated estrogens in the perinatal period","volume":"7","author":"Kenny","year":"1973","journal-title":"Pediatr. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0304-4165(80)90321-9","article-title":"The mechanism of estrogen-induced increase in hyaluronic acid biosynthesis, with special reference to estrogen receptor in the mouse skin","volume":"627","author":"Uzuka","year":"1980","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1597\/1545-1569_1996_033_0023_protuc_2.3.co_2","article-title":"Primary Repair of the Unilateral Cleft Lip Nose: Completion of a Longitudinal Study","volume":"33","author":"McComb","year":"1996","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1097\/00006534-198506000-00003","article-title":"Primary correction of unilateral cleft lip nasal deformity: A 10-year review","volume":"75","author":"McComb","year":"1985","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/00006534-199909010-00002","article-title":"Nonsurgical correction of nasal deformity in unilateral complete cleft lip: A 6-year follow-up","volume":"104","author":"Bennun","year":"1999","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"509","DOI":"10.17219\/dmp\/145065","article-title":"Prevalence of Simonart\u2019s band in cleft children at a cleft center in Indonesia: A nine-year retrospective study","volume":"59","author":"Ariawan","year":"2022","journal-title":"Dent. Med. Probl."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00006534-198901000-00006","article-title":"Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period","volume":"83","author":"Matsuo","year":"1989","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/SCS.0000000000007026","article-title":"Nasoalveolar Molding: Assessing the Burden of Care","volume":"32","author":"Wlodarczyk","year":"2021","journal-title":"J. Craniofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1177\/1055665620936056","article-title":"Sociodemographic Factors That Influence the Choice to Pursue Nasoalveolar Molding: One Pediatric Hospital\u2019s Experience","volume":"57","author":"Kimia","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/1055665617718550","article-title":"Factors Associated with Adherence to Nasoalveolar Molding (NAM) by Caregivers of Infants Born with Cleft Lip and Palate","volume":"55","author":"Esmonde","year":"2018","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0042-1744219","article-title":"The Burden of Care in Nasoalveolar Molding Treatment in Cleft Patients","volume":"55","author":"Magyar","year":"2022","journal-title":"Indian J. Plast. Surg."},{"key":"ref_33","unstructured":"Walker, N.J., Anand, S., and Podda, S. (2022). Cleft Lip, StatPearls Publishing."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/S0140-6736(18)32485-1","article-title":"Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): An international, multicentre, randomised, controlled equivalence trial","volume":"393","author":"McCann","year":"2019","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1111\/apa.14943","article-title":"Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): An international, multicentre, randomised, controlled equivalence trial","volume":"108","author":"Shukla","year":"2019","journal-title":"Acta Paediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/ANA.0000000000000346","article-title":"Report on the Fifth PANDA Symposium on \u201cAnesthesia and Neurodevelopment in Children\u201d","volume":"28","author":"Miller","year":"2016","journal-title":"J. Neurosurg. Anesthesiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Paradowska-Stolarz, A., Mikulewicz, M., and Du\u015b-Ilnicka, I. (2022). Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients-A Comprehensive Review. J. Pers. Med., 12.","DOI":"10.3390\/jpm12122089"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jpedsurg.2007.12.006","article-title":"Neonatal repair of cleft lip: A decision-making protocol","volume":"43","author":"Galinier","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/01.prs.0000479979.83169.57","article-title":"Surgeon\u2019s and Caregivers\u2019 Appraisals of Primary Cleft Lip Treatment with and without Nasoalveolar Molding: A Prospective Multicenter Pilot Study","volume":"137","author":"Broder","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1097\/PRS.0b013e31829b69fe","article-title":"A Comparative Cost Analysis of Cleft Lip Adhesion and Nasoalveolar Molding before Formal Cleft Lip Repair","volume":"136","author":"Shay","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"39019","DOI":"10.1038\/srep39019","article-title":"The functional architecture of mother-infant communication, and the development of infant social expressiveness in the first two months","volume":"6","author":"Murray","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1177\/0890334417706062","article-title":"Breastfeeding After Early Repair of Cleft Lip in Newborns with Cleft Lip or Cleft Lip and Palate in a Baby-Friendly Designated Hospital","volume":"33","author":"Burianova","year":"2017","journal-title":"J. Hum. Lact."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1016\/j.pedn.2022.12.011","article-title":"Breastfeeding and maternal attachment: The moderating roles of maternal stress and child behavior","volume":"69","author":"Barrios","year":"2023","journal-title":"J. Pediatr. Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1097\/PRS.0000000000006831","article-title":"Nasolabial Revisions in Unilateral Incomplete Cleft Lip: One Surgeon\u2019s 28-Year Experience","volume":"145","author":"Tan","year":"2020","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/SAP.0000000000001935","article-title":"Incidence of Secondary Lip Correction for Children with Unilateral Cleft Lip: A Single-Center Retrospective Study","volume":"83","author":"Zhang","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1597\/14-202","article-title":"The Burden of Care for Children with Unilateral Cleft Lip: A Systematic Review of Revision Surgery","volume":"53","author":"Sitzman","year":"2016","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/01.GOX.0000938336.05489.87","article-title":"A Comparison of Revision Rates in Patients Undergoing Traditional Versus Neonatal Cleft Lip Repair","volume":"11","author":"Alfeerawi","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1097\/SCS.0000000000001729","article-title":"Comparative Study of Early Secondary Nasal Revisions and Costs in Patients with Clefts Treated with and Without Nasoalveolar Molding","volume":"26","author":"Patel","year":"2015","journal-title":"J Craniofac Surg"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0140-6736(15)00608-X","article-title":"Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): An international multicentre, randomised controlled trial","volume":"387","author":"Davidson","year":"2016","journal-title":"Lancet"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1741\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:00:47Z","timestamp":1760130047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101741"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101741","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,28]]}}}