title: International Adoptees With Cleft Lip and/or Palate: Lessons Learned From a Growing Population.
abstract: BACKGROUND
  International adoptees with cleft lip and palate (CLP) are a growing population in the United States. They represent a clinical challenge, presenting at various ages and stages of cleft repair.
  
  
  METHODS
  A retrospective review of patients seen at the CLP Program at the Children's Hospital of Philadelphia (CHOP) between 1998 and 2012 with a history of international adoption was performed. Demographics, surgical histories, and long-term speech outcomes were reviewed.
  
  
  RESULTS
  Seventy-four female and 77 male patients were evaluated. Patients were adopted at an average age of 2.3 years (range, 0.4-8.6 years); 80.8% (n = 122) of patients were adopted from China. The rate of international cleft adoption increased by approximately 1.5 patients per year (r = 0.7739, P < 0.001); 13.2% (n = 19) of all subjects with cleft palates had oronasal fistulas (ONFs) that required repair. The ONF rates for primary palatoplasties at CHOP were significantly lower compared to both preadoption repairs (P = 0.002) and postadoption repairs at outside hospitals (P = 0.01); 14.8% (n = 21) of all patients had secondary surgeries for velopharyngeal incompetence (VPI). Rates of secondary surgery for VPI were also significantly lower for primary palatoplasties at CHOP compared to both preadoption repairs (P = 0.0018) and postadoption repairs at outside hospitals (P = 0.0033).
  
  
  CONCLUSIONS
  International adoptees with CLP are a growing population and are clinically challenging with high ONF rates and high secondary surgery rates for VPI. We recommend expedited repair of unoperated cleft palates in adoptees older than 18 months. Adopted patients with CLP should be rigorously evaluated for the need for speech therapy and secondary surgeries to correct for VPI.
authors.affiliation: From the *Division of Plastic Surgery, Mount Sinai Hospital, New York, NY; †Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh; ‡Division of Plastic Surgery, and §International Adoption Health Program, Children's Hospital of Philadelphia; and ‖Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Paul Luther
authors.initials: PL
authors.lastname: Shay
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Paliga
authors.forename: Cynthia B
authors.initials: CB
authors.lastname: Solot
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Cohen
authors.forename: Susan A
authors.initials: SA
authors.lastname: Friedman
authors.forename: David W
authors.initials: DW
authors.lastname: Low
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Jackson
mesh_terms: D000300:Adoption / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000208:ethnology; D002971:Cleft Lip / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D056948:Orthognathic Surgical Procedures; D015143:Philadelphia; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery