Customized protective palatal obturator for intubation in newborns in cleft lip surgery: a randomized controlled trial

Orofacial clefts are common congenital malformations, affecting both facial aesthetics and function. Intubation in newborns with cleft lip and palate is challenging and carries a high risk of oral tissue damage. This study investigates the use of a customized protective palatal obturator (CPPO) to improve intubation safety and reduce tissue injury during cleft lip surgery. A single-center, randomized neonatal sub-study was conducted, including 55 newborns who underwent cleft lip surgery. Patients were randomized into an intervention group (CPPO use) and a control group (standard intubation without CPPO). The primary aim was to evaluate the degree of oral tissue injury during intubation, its severity, and location, in both groups, secondary aims included laryngoscopy image during intubation (modified Cormack-Lehane scoring system), intubation time, and attempts, number of intubations attempts and anesthesiologic complication during intubation. This study was registered on www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT04422847 and NCT04422964). No tissue damage occurred in the CPPO group, while the control group had a 21.4% incidence of tissue injury (<i>p</i> = .023). Secondary outcomes showed no statistically significant differences between groups for intubation time or the number of intubation attempts. Difficult intubation was less frequent in the CPPO group (40.7%) compared to the control group (50%), though this difference was not statistically significant. The CPPO significantly reduces the risk of tissue damage during intubation in newborns undergoing cleft lip surgery, without increasing intubation time or attempts. It is particularly beneficial for severe clefts, and its use may facilitate safer airway management in these high-risk patients. Customized protective palatal obturators enhance intubation safety in newborns with cleft lip, alveolus and palate.The customized protective palatal obturator is especially advantageous for patients with more severe clefts, offering better protection against tissue damage during intubation.The customized protective palatal obturator does not prolong intubation time or increase the number of intubation attempts, making it an effective tool for better airway management without added difficulty or delay. Customized protective palatal obturators enhance intubation safety in newborns with cleft lip, alveolus and palate. The customized protective palatal obturator is especially advantageous for patients with more severe clefts, offering better protection against tissue damage during intubation. The customized protective palatal obturator does not prolong intubation time or increase the number of intubation attempts, making it an effective tool for better airway management without added difficulty or delay.