Dental Development, Airway, and Respiratory Challenges in Children Undergoing Cleft Lip and Palate Repair: A Systemic Review

Abstract

Background:  CLP is a congenital anomaly defined as the failure of facial processes to merge, resulting in the formation of an opening between mouth and nose, gum, and alveolar process; CLP has been associated with dental maturity delay, airway obstruction, and respiratory-related complications. The surgical repair of cleft lip and palate’s main goal is to restore the normal function of the child’s face and mouth, but it brings some new problems, especially in cases of children. Appreciation of the relationship between dental, respiratory, and airway issues is important to maximize patient care during and after surgery. Objective: The purpose of this systematic review is to evaluate the dental maturation, airway, and respiratory issues of children who have undergone cleft lip and palate repair in the years between 2017 and 2022, focused on dentistry for children, oral anatomy, anesthesia, and orthodontics. Methodology: A survey of relevant studies was also done in the PubMed, Scopus, and Cochrane databases, focusing on articles published between 2017 and 2022. The selection criteria used included studies that described dental maturation, airway management, and respiratory outcomes of children after CLP repair. A total of 30 studies were included; patient characteristics, dental development, airway-related complications, respiratory-related problems, and management of anesthesia were abstracted. To measure the risk of bias, the Cochrane tool was applied. Results: The review established delayed dental maturation and/or malocclusion in 62% of children after CLP repair, with Class III malocclusion being the most frequent. Airway complications in general and OSA in particular were reported in 38 percent of children. The most common complaints were respiratory infections and/or chronic upper airway issues, with rates above 40 percent among the patients who also underwent secondary procedures. Airway management complications related to anesthesia were reported in 33% of the studies; however, interventions before surgery were found to have dramatically lowered intraoperative risks. Conclusion: Children who receive CLP repair often suffer dental maturation arrest, airway problems, and respiratory. They included early timing of the orthodontic treatment, proper perioperative airway management, and assessment of respiratory infections. Perioperative care guidelines require further study to identify safer strategies for treatment and examine the lifelong consequences of respiratory and dental issues.