PURPOSE STATEMENT: Traditionally, after cleft lip and/or palate repair surgery children are required to wear elbow restraints to prevent traumatic disruption of the incision in the early postoperative period. The literature is lacking significant randomized prospective research demonstrating true benefit of arm splints. Our center is currently conducting such a study. As part of this project we surveyed all cleft palate centers in North America regarding use of post-operative arm splints to gauge the variability of arm splint use and to discover factors leading to surgeon decision in the absence of research data.

METHODS: A questionnaire was mailed to each of the 224 cleft palate centers in North America. Questions asked included which, if any, patients are treated with post operative splints, which factors influence the decision to use splints, how long the use of splints are continued post-operatively, and whether or not parents are allowed to remove the splints. Additionally, the respondents were asked whether their personal preference to use or not use splints was a result of training, personal experience, or personally conducted research.

RESULTS: Overall response rate was 49%. 55% of respondents report using splints for all post operative patients. 39% of respondents reported using splints in some of their patients. 6% of centers do not use splints for any patients. Amongst centers using splints in only some of their patients the most common factors influencing the decision to use splints were age and temperament of the patient.

CONCLUSIONS: The vast majority of cleft palate centers use arm splints for at least some patients, although their application of splinting varies widely. Few surgeons base splinting decisions on personally conducted research. Most surgeon decisions are made based on training and anecdotal evidence. These results point to a real need for scientifically based outcomes research on the efficacy of splint use in patients with cleft lip and/or palate