Success and Failure for Children Born with Facial Clefts in Africa: A 15‐Year Follow‐up

Abstract

Background This study reviews the 15 year program of our Department of Pediatric Surgery for the treatment and follow-up of children born with a cleft in Benin and Togo. Methods We analyzed files of children born in Africa with a cleft. They were referred to us through a nongovernmental organization (NGO) between 1993 and 2008 and assessed in Africa by local pediatricians before and after surgery. Operations were performed by our team. Results Two hundred files were reviewed: 60 cases of unilateral cleft lip, seven of bilateral cleft lip, 44 of unilateral cleft lip palate (UCLP), 29 of bilateral cleft lip palate (BCLP), 53 of cleft palate (CP), three of bilateral oro-ocular cleft, one of unilateral and two of median clefts (Binder), and one of commissural cleft. Sixty-nine (35 %) of these cases were not operated in Africa: 25 (12.5 %) had not shown up, 28 (15 %) were considered unfit for surgery (Down's syndrome, HIV-positive, malnutrition, cardiac malformation), and 16 (7.5 %) were transferred to Switzerland. Palatal fistula occurred in 20 % of UCLP, 30 % of BCLP, and 16 % of CP. Evaluation of speech after palate surgery gave less than 50 % of socially acceptable speech.Conclusions Our partnership with a NGO and a local team makes it possible to treat and subsequently follow children born with a cleft in West Africa. Surgery is performed under good conditions. If aesthetic results are a success, functional results after palate surgery need further improvement to promote integration in school and social life.

Charitable Platforms in Global Surgery: A Systematic Review of their Effectiveness, Cost‐Effectiveness, Sustainability, and Role Training

“…Although there are obviously patient-level factors that confound this increased complication rate, this finding lends further credence to an assertion that mission volume has potentially more impact than surgeon experience [53]. De Buys Roessingh et al [42] similarly report relatively poor functional results in the repair of cleft palates on short-term surgical missions; the inherent difficulty of establishing a multidisciplinary approach in short-term surgical missions may contribute to these outcomes [54]. …”

“…These missions, also called safaris [39] or blitzes [40], frequently carry their own equipment with them [38, 41], often return to the same region in subsequent years [24, 42–44], and strive toward close partnership with local hospitals and ministries of health [45, 46]. …”

An Evaluation of the Value of Plastic Surgery Mission Trips in Resident Education by Attending Physicians

“…For example, several studies suggest that postsurgical follow-up and on-site resources are frequently lacking. 5,6 These deficiencies can impact resident training and diminish the quality of care provided to patients. In addition, data suggest that there remains a need for feedback on and critical evaluation of the quality of mission trips to improve the outcome of surgical procedures.…”

Pay It forward: Strategies for Successful Implementation of Short-term Endocrine Surgical Mission

“…Of the 24 articles reviewed, mission trips were reported on 4 different continents. The majority went to Africa (9), [7][8][9][10][11][12][13][14][15] North America (8), [16][17][18][19][20][21][22][23] South America (5), 9,21,[24][25][26] and Asia (5) 9, 27-30 ; 67% of these trips included surgical trainees, 42% were plastic surgery-focused, and 37% were general/orthopedic surgery-focused (Graph 1). No manuscript detailed a mission trip specific to endocrine surgery.…”