Bridging the gap in orofacial cleft care diagnosis, education and treatment

This thesis aimed to improve treatment strategies for patients with orofacial clefts (OFCs) in order to reduce velopharyngeal insufficiency (VPI) and the need for revision surgery. A major focus was the standardization of classification systems to enable accurate comparison of outcomes nationally and internationally, thereby improving outcome prediction and counseling for patients and their families.
An evaluation of commonly used classification systems highlighted the importance of simplicity, flexibility, precision, and clarity. More elaborate systems, such as LAHSHAL in combination with ICD-10, provide greater morphological and etiological detail and facilitate improved communication, research, and reimbursement. However, variability in the use of classification systems for palatal fistulae remains problematic, as low inter-rater reliability can lead to miscommunication. Standardized training is therefore essential to ensure consistent classification and identification of risk factors.
Surgical management of palatal fistulae requires careful planning due to high recurrence rates. Most specialists favor a two-layer closure, while the use of acellular dermal matrices was associated with higher fistula rates and additional disadvantages related to cost and infection risk.
Delayed diagnosis of submucous cleft palate and Robin Sequence remains a significant concern and is associated with speech, hearing, and systemic complications. Differences in diagnostic resources across Europe further emphasize the need for a feasible, uniform diagnostic protocol.
Advances in prenatal screening have reduced the prevalence of cleft lip with or without palate at birth, while healthcare disruptions such as the COVID-19 pandemic have highlighted the importance of surgical prioritization. Digital collaboration and smart surgical technologies offer promising tools to enhance education, strengthen global partnerships, and promote equitable, high-quality cleft care worldwide.