Questioning the Relevance of Normal White Blood Cell Count under 10,000 Cells per Microlitre in Millard Criteria as an Absolutely Required Parameter for Cleft Lip Repair Surgeries: A Case-Based Literature Review

Leukocytosis, defined as an elevated white blood cell count, has long been regarded as a crucial indicator of inflammation or infection in surgical procedures. In the context of cleft lip surgeries, normal white blood cell count has often been considered an absolute requirement for proceeding with the procedure, as it is believed to signal the presence of a potentially infectious or inflammatory state. Therefore, leukocytosis is thought to be a strong precautionary factor. However, recent evidence challenges this long-held belief, suggesting that elevated white blood cell counts may not necessarily be indicative of adverse outcomes in cleft lip surgeries. To explore this notion, we conducted a comprehensive literature review focusing on two case studies involving unilateral cleft lip patients with presurgical white blood cell counts exceeding 10,000 per microlitre. Both cases underwent successful cleft lip repair and demonstrated excellent post-surgical outcomes without any signs of inflammation or infection. Both cleft lip repair surgeries results showed no complications, and the patient exhibited optimal wound healing and an aesthetically pleasing outcome at the follow-up appointments. These cases challenge the assumption that normal white blood cell count is an absolute requirement for cleft lip surgeries and call for a reconsideration of its significance in predicting post-surgical outcomes. While leukocytosis is an essential parameter to identify potential infectious or inflammatory states, our findings suggest that it should not be solely relied upon in isolation when assessing the suitability for cleft lip surgery and predicting the adverse outcomes in cleft lip surgeries. Further studies are warranted to establish a more nuanced understanding of leukocytosis in the context of cleft lip surgeries, including its association with other clinical parameters and potential alternatives for evaluating surgical candidacy and predicting the adverse outcomes in cleft lip surgeries.