No link found between oral cleft surgery and cognitive impairment

Since the definite age of maximum vulnerability to general anaesthesia is still unknown and widely debated, it is unclear whether academic achievement among adolescents is affected by having undergone oral cleft surgery at an early age. The research group, led by Dr Nicola G. Clausen, suspected that any potential neurotoxic effect caused by extensive exposure to anaesthesia at an early age would show up in poor results in ninth-grade final examinations.

The study was based on 558 adolescents identified from a nationwide Danish registry who had undergone surgery for cleft lip, cleft palate or both when they were young. The researchers found that 509 of the adolescents in the group had been exposed to anaesthesia and had undergone at least one cleft operation in their lives. They compared the level of academic achievement of the students in the registry against that of a control group.

Although the children with a cleft lip, cleft palate or both had been exposed to anaesthesia early and often, the researchers found no significant difference between the ninth-grade test scores of the teens with a cleft lip, or both a cleft lip and a cleft palate and the scores of teenagers in the control group. However, the students with only a cleft palate had lower test scores than the students in the control group. Children with a cleft palate only are generally older when surgery is performed than children with other types of clefts.

“Studies like the present one cannot definitely prove that anesthetic drugs do not harm developing brains. However, it can put the potential threats into perspective because other factors more importantly impact these children’s neurocognitive development,” said Clausen.

The researchers concluded that the type of oral cleft, rather than the timing of anaesthesia or the number of cleft operations, is linked to poorer academic performance. Although the researchers saw no evidence in their study to suggest that surgeons need to change their anaesthesia methods, a neurotoxic effect due to anaesthetics cannot be dismissed completely.

The study, titled “Oral clefts and academic performance in adolescence: The impact of anesthesia-related neurotoxicity, timing of surgery, and type of oral clefts”, was published in the July issue of the Cleft Palate–Craniofacial Journal.

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