Longitudinal Treatment of Cleft Lip and Palate in Developing Countries

Abstract

Cleft lip and palate affects roughly 1 in 600 children and predisposes patients to a lifetime of functional and esthetic discrepancies. Disparities in access as well as quality of care exist worldwide, with many children in developing countries unable to receive treatment. In the late 20th century, humanitarian medical missions emerged as a means of delivering surgical expertise to patients in resource-limited settings. These early missions took on a patient-centered approach focused solely on cleft repair, with little emphasis on treating the dental abnormalities that arose after the initial surgery. However, modern cleft care is characterized by a multidisciplinary, team-based approach with significant dental involvement. Recent cleft lip and palate endeavors have shifted from a mission-based approach to a developmental approach facilitating growth of an independent care center. This strategy focuses on creating an institution with expanded access to dental services, thus facilitating the long-term treatment inherent in modern cleft care. One clinic in a developing country that has experienced successful transitioning from a mission site to an independent craniofacial clinic is Operation Smile's Cleft Comprehensive Care Clinic in Guwahati, India. This article will summarize the rationale and planning of the clinic, underscore the team-based approach required in longitudinal treatment of cleft lip and palate, and demonstrate how treatment methodology may differ in resource-limited settings by outlining the therapeutic considerations of each provider in the Guwahati Clinic.

The Expanding Role of Education and Research in International Healthcare

“…As this model carefully ties high clinical volume with academic interests, research done through Operation Smile local centers has resulted in over 25 publications, [16][17][18][19][20][21][22][23][24][25][26] with almost 20 coming from GC4 alone. 10,[13][14][15][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Operation Smile India spent 2 preliminary years studying the government, culture, and infrastructure of Assam to develop the successful model for sustainable care that is GC4. 14,15,27 Unique methods were developed to recruit patients through nonmedical screening personnel in the community, because 87% of the population of Assam lives in rural and isolated areas.…”

World Cleft Coalition International Treatment Program Standards

“…There is also a gradation of care delivered in international settings. Treatment models vary and there is no standardization of cleft care that defines the involvement of international teams (Shaw et al, 2005; Lee et al, 2014; Percy et al, 2015). This can result in well-intentioned international treatment programs combining medical trips with medical tourism or teams traveling into remote resource areas without the proper safety provisions.…”

Patients With a History of Oronasal Fistula Repair Exhibit Lower Oral Health Measured With Patient-Centric Outcomes Measures

“…Patients require long-term, multidisciplinary care as this condition affects multiple aspects of orofacial health and psychosocial development. Care is long-term, lasting from infancy through skeletal maturity and into adulthood (Cohen et al, 1995; DeLuke et al, 1997; Nahai et al, 2005; Lee et al 2014). The goals of cleft care include normalization of appearance, speech, facial growth, dental health, occlusion, and oral health and support of psychosocial development while limiting the number of surgical interventions and morbidity.…”