Abstract
Evaluation and treatment of cleft lip/palate (CLP) patients in low-resource settings must prioritize safety by anticipating specific logistical, clinical, and surgical challenges. Surgical evaluation includes a comprehensive diagnosis of each patient’s deformity and overall medical status. A treatment plan should be proposed and/or updated and, also, must be agreed by the patient’s family. The treatment plan should match the patient’s overall treatment strategy and the provider team capabilities. Prioritization is often necessary to fit the surgical capacity and can be aided by classification schemes, overall health assessment, patient geography, and team resources. The treatment approach should be guided by a thorough set of care standards, to ensure the best and safest possible surgical outcomes. The protocols and techniques used in the MOS must adapt to the limitations of local infrastructure, the geographical and socioeconomic status of the population, and the barriers for accessing short- and long-term follow-up.
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References
Berger JH, Jian Z, O’Reilly EB, Christman MS. First do no harm: predicting surgical morbidity during humanitarian medical missions. World J Surg. https://doi.org/10.1007/s00268-018-4720-9.
Melookaran AM, Rao SA, Antony SB, Herrera A. Anesthesia for children with craniofacial abnormalities in the developing countries: challenges and future directions. J Craniofac Surg. 2015;26:1069–72.
Calis M, Aral AM, Sencan A, Kanbak M, Vargel I, Ozgur F, Iscen D. Humanitarian activities of Interplast Turkiye: 6 years of experience in Uzbekistan for surgical treatment of cleft patients and related secondary deformities. Ann Plast Surg. 2016;77:494–8.
Moses JJ, Rochelle WJ. Cleft and craniofacial mission care management of facial clefts: international missions. Oral Maxillofac Surg Clin North Am. 2016;28:203–20.
Operation smile. Resource manual. Global standards of care.
Braun TL, Louis MR, Dickey RM, Buchanan EP. A sustainable and scalable approach to the provision of cleft care: a focus on safety and quality. Plast Reconstr Surg. 2018. https://doi.org/10.1097/PRS.0000000000004580.
Chao TE, Riesel JN, Anderson G, Mullen JT, et al. Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience. J Surg Ed. 2015. https://doi.org/10.1016/j.jsurg.2014.12.018.
Carlson LC, Stewart BT, Hatcher KW, Kabetu C, VanderBurg R, Magee WPA. Model of the unmet need for cleft lip and palate surgery in low- and middle-income countries. World J Surg. 2016;40:2857–67.
Zaidi SH, Rehman JU, Rahman HU, Ahmed N. Lip adhesion– a viable alternative to pre-surgical orthodontics for the management of wide cleft lips in third world countries. J Ayub Med Coll Abbottabad. 2018;30(2):171–4.
Grayson BH. Discussion: limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg. 2013;131:75e–6e.
Rosell-Perry P, Segura E, Salas- Butinza L, Cotrina-Rabanal O. Comparison of two models of surgical care for patients with cleft lip and palate in resource-challenged settings. World J Surg. 2013. https://doi.org/10.1007/s00268-013-2395-9.
Monson LA, Kirschner RE, Losee JE. Primary repair of cleft lip and nasal deformity. Plast Reconstr Surg. 2013;132:1040e.
Marcus JR, Allori AC, Santiago PE. Principles of cleft lip repair: conventions, commonalities, and controversies. Plast Reconstr Surg. 2017;139:764e.
Agrawal K, Panda KA. Modified surgical schedule for primary management of cleft lip and palate in developing countries. Cleft Palate Craniofac J. 2001;48:1.
Hughes C, Campbell J, Mukhopadhyay S, McComrmack S, Silverman R, Lalikos J, Babigian A, Castiglione C. Remote digital preoperative assessments for cleft lip and palate may improve clinical and economic impact in global plastic surgery. Cleft Palate–Craniofac J. 2017;54:535–9.
Roy AA, Rtshiladze MA, Stevens K, Phillips J. Orthognathic surgery for patients with cleft lip and palate. Clin Plast Surg. 2019;46(2):157–71.
Laub DR. Globalization of craniofacial plastic surgery: foreign Mission programs for cleft lip and palate. J Craniofac Surg. 2015;26:1015–31.
Hughes CD, Babigian A, Alkire BC, Wong A, Papp SA, Vincent JR, Meara JG, Castiglione C, Silverman R. The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings. Plast Reconstr Surg. 2012;130:87e.
Best DL, Gauger TL, Dolan LA, Donnelly A, Ranganathan K, Ulloa-Marin C, Sung-Hsieh HH. Orofacial cleft management by short-term surgical missions in South America: literature review. 2018. Int J Oral Maxillofac Surg. https://doi.org/10.1016/j.ijom.2018.05.025.
Swanson MA, Auslander A, Morales T, et al. Predicators of complication following cleft lip and palate surgery in a low-resource settings: a prospective outcomes study in Nicaragua. Presentation at the European Cleft Palate Association. Utrecht; June 2019.
Murthy J, Sendhilnathan S, Hussain SA. Speech outcome following late primary palate repair. Cleft Palate Craniofac J. 2010;47(2):156–61.
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Sierra, N.E., Bohórquez, D., Rocha, D.L., Lopes-Gamborgi, M.A. (2021). Surgical Evaluation, Diagnosis, and Treatment Planning. In: Swanson, J.W. (eds) Global Cleft Care in Low-Resource Settings. Springer, Cham. https://doi.org/10.1007/978-3-030-59105-2_7
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