Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery

2017 ◽  
Vol 54 (5) ◽  
pp. 535-539 ◽  
Author(s):  
Christopher Hughes ◽  
Jacob Campbell ◽  
Swagoto Mukhopadhyay ◽  
Susan Mccormack ◽  
Richard Silverman ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Plastic Surgery ◽  
Cleft Lip ◽  
Digital Video ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Short Term ◽  
Middle Income ◽  
Alveolar Cleft ◽  
Middle Income Countries

Objective Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. Setting The setting for this study was a district hospital located in Latacunga, Ecuador. Patients Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. Main Outcome Measures We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Results Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P .74). Conclusions Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

scholarly journals An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Pratik B. Patel ◽  
Marguerite Hoyler ◽  
Rebecca Maine ◽  
Christopher D. Hughes ◽  
Lars Hagander ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Surgical Care ◽  
Surgical Capacity ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Resource Limited ◽  
Care Delivery Model

Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

Efficacy of Facilitated Capacity Building in Providing Cleft Lip and Palate Care in Low- and Middle-Income Countries

2017 ◽  
Vol 28 (7) ◽  
pp. 1737-1741 ◽  
Author(s):  
Hillary E. Jenny ◽  
Benjamin B. Massenburg ◽  
Saurabh Saluja ◽  
John G. Meara ◽  
Mark G. Shrime ◽  
...  
Keyword(s):  
Capacity Building ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abnormal Maxillary Trapezoid Pattern in Human Fetal Cleft Lip and Palate

2008 ◽  
Vol 45 (2) ◽  
pp. 131-140 ◽  
Author(s):  
Soung Min Kim ◽  
Young Joon Lee ◽  
Sang Shin Lee ◽  
Yeon Sook Kim ◽  
Suk Keun Lee ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Nasal Septum ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Growth Patterns ◽  
Radiographic Images ◽  
Alveolar Cleft ◽  
Abnormal Growth ◽  
Bilateral Cleft Lip ◽  
Different Types

Objective: To elucidate abnormal growth patterns of human fetal maxillae with cleft lip and palate (CLP). Subject: A total of 71 fetal maxillae with CLP were obtained from aborted human fetuses. Method: Dimensions of the maxillary trapezoid (MT), formed by the maxillary primary growth centers (MxPGC), were taken from radiographic images. The CLP dimensions were compared with maxillary trapezoid dimensions of normal fetuses from a previous study (Lee et al., 1992). Main Outcome Measures: Cleft lip subjects without a cleft palate, unilateral cleft lip-alveolar cleft or cleft palate (UCL+A/UCLP), and bilateral cleft lip-alveolar cleft or cleft palate (BCL+A/BCLP) displayed abnormal MT patterns. MT abnormalities were most marked in the BCL+A/BCLP cohort. Results: The MT growth of prenatal CLP maxillae was severely arrested, resulting in abnormal MT shape on palatal radiograms. BCL+A/BCLP subjects had a more protruded nasal septum than subjects with other types of CLPs, while UCL+A/UCLP subjects showed severe deviation of the protruded nasal septum toward the noncleft side. Cleft lip-only subjects also exhibited abnormal MT growth. Conclusion: MT is primarily involved in CLPs, so that the MT shape could be utilized as a sensitive indicator for the analysis of maxillary malformation in different types of CLPs.

scholarly journals Adapting cleft care protocols in low- and middle-income countries during and after COVID-19: a process-driven review with recommendations

2021 ◽  
Author(s):  
Matthew John Fell ◽  
Michael Goldwasser ◽  
BS Jayanth ◽  
Rui Manuel Rodrigues Pereira ◽  
Christian Tshisuz Nawej ◽  
...  
Keyword(s):  
Working Group ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Providers ◽  
Resource Constrained ◽  
Middle Income ◽  
Middle Income Countries ◽  
International Working Group ◽  
Consensus Recommendations ◽  
Low And Middle Income

Objective: A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptions to cleft care protocols during and after COVID as a priority learning area of need. Design: A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptions to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organisations involved in comprehensive cleft care. Results: Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery protocols were scrutinised and COVID adaptions, specifically in the pre and peri-operative periods, were highlighted. Second, surgical operations and access to services were prioritized according to their relationship to functional outcomes and time-sensitivity. The operations assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft services assigned the highest priority were new-born assessments, paediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. Conclusions: A collaborative, interdisciplinary and international working group delivered consensus recommendations to assist with the provision of cleft care in low- and middle-income countries. At a time of global cleft care delays due to COVID-19, a united approach amongst global cleft care providers will be advantageous to advocate for children born with cleft lip and palate in resource-constrained settings.

Cleft Missions: Don't Miss the Opportunity: A Special Opinion Piece

2015 ◽  
Vol 25 (1) ◽  
pp. 39-43
Author(s):  
Sally J. Peterson-Falzone
Keyword(s):  
Developing Countries ◽  
Clinical Experience ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Term Therapy ◽  
Short Term ◽  
Speech Language Pathologists ◽  
Opinion Piece ◽  
Patient Will

Missions to developing countries to provide surgical care for children and adults with cleft lip and palate constitute unique opportunities for speech-language pathologists (SLPs). The SLP helps determine if a patient will actually benefit from a planned procedure, and occasionally has the chance to perform short-term therapy. The clinical experience gained on a 2-week mission is invaluable.

A Model of the Unmet Need for Cleft Lip and Palate Surgery in Low- and Middle-Income Countries

2016 ◽  
Vol 40 (12) ◽  
pp. 2857-2867 ◽  
Author(s):  
Lucas C. Carlson ◽  
Barclay T. Stewart ◽  
Kristin W. Hatcher ◽  
Charles Kabetu ◽  
Richard VanderBurg ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Unmet Need ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Establishing a Comprehensive Ethics-Based Checklist for Surgical Camp Activities at AMPATH-Kenya

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Diane B. Choi, BS ◽  
Kyle L. Carpenter, MD ◽  
Connie H. Keung, MD
Keyword(s):  
Experimental Design ◽  
Surgical Care ◽  
Standards Of Care ◽  
Government Agencies ◽  
Anesthesia Care ◽  
Short Term ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Training And Research

Background and Hypothesis: Global health has made strides in controlling and reducing harm from infectious diseases such as Polio and HIV/AIDS but this focus has not been mirrored in surgical and anesthesia care, especially in many low and middle-income countries (LMICs). In 2010, an estimated 16.9 million lives were lost from conditions that required surgical care and 5 billion people in LMICs lack safe and affordable surgical and anesthesia. Organization of surgical camps can bring skilled physicians to temporarily meet the unmet surgical needs in underserved areas. However, currently there are no government agencies or accrediting bodies existing to assess the scope/impact of short-term surgical camp care or establish standards of care for such services.   Experimental Design or Project Methods: The AMPATH mission of “start with healthcare and then do more to empower communities, educate tomorrow’s medical experts and research breakthroughs that will truly change the health of the world” was incorporated into the ethical checklist proposed. The four principles – beneficence, non-maleficence, autonomy, and justice were used as guidance for the checklist.   Results: The checklist can be organized into three main areas: Care, Empowerment & Training, and Research (Figure 1).

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate

2020 ◽  
pp. 105566562098024
Author(s):  
Kim Bettens ◽  
Laura Bruneel ◽  
Cassandra Alighieri ◽  
Daniel Sseremba ◽  
Duncan Musasizib ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Speech Therapy ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
English Speaking ◽  
And Gender ◽  
Early Primary ◽  
Velopharyngeal Function ◽  
Normal Speech

Objective: To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Design: Prospective case–control study. Setting: Referral hospital for patients with cleft lip and palate in Uganda. Participants: Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Interventions: Comparison of speech outcomes of the patient and control group. Main Outcome Measures: Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Results: Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children ( P < .05). Conclusions: Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals Alveolar cleft and maximum cleft width as predictors for difficult laryngoscopy and intubation in patients with unilateral complete cleft lip and palate

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Gamal A. Abdelhameed ◽  
Wael A. Ghanem ◽  
Simon H. Armanios ◽  
Tamer Nabil Abdelrahman
Keyword(s):  
Body Weight ◽  
Odds Ratio ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Difficult Laryngoscopy ◽  
Secondary Outcome ◽  
Pediatric Airway ◽  
Alveolar Cleft ◽  
Cleft Lip Palate ◽  
Width Measurements

Abstract Background Cleft lip and palate is one of the commonest congenital anomalies, which have an impact on feeding, speech, and dental development away from the significant psychosocial sequel. Early surgical repair aims to restore appearance and function, and the modern techniques can leave many defects undetectable. Therefore, the anesthetic challenge facing the pediatric airway with such abnormalities is still of a great impact. The aim of our study among 189 patients enrolled is to correlate alveolar gap and maximum cleft width measurements as predictors of difficult laryngoscopy and intubation in infants with unilateral complete cleft lip/palate aging from 1 to 6 months. As a secondary outcome, their weight is to be correlated too as another parameter. Results The alveolar gap and maximum cleft width are both of equal high predictive power (p value ≤ 0.001) with 100% sensitivity for both and specificity of 76.10% and 82.39% respectively, with a cut off value of ≤ 10 mm and 11 mm for these dimensions respectively, and odds ratio of incidence of difficult intubation is 4.18 and 5.68 respectively, while body weight ≤ 5.75 kg has an odds ratio of 2.32. Conclusion Alveolar cleft and maximum cleft width can be used as predictors for anticipation of difficult laryngoscopy and intubation infant patients with unilateral complete cleft lip and palate, while body weight ≤ 5.75 kg increases the risk more than twice.

Sign in / Sign up

Export Citation Format

Share Document