Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Cleft Lip and Palate Surgery in Developing Countries
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cess in mind during screening is important. Providing patients and families with
accurate, honest information is essential. Although we work with our in-country
partners ahead of the mission to identify patients suffering from cleft deformities, it
should not be assumed that patients and families understand the specific surgery
that may be performed. A child may have a cleft lip but a parent may be more
interested in having the child’s ear microtia addressed. Misunderstandings can be
especially common with patients suffering from multiple deformities or syndromes.
Accurately portraying the surgical result is also important. It is important that patients
and families are given a realistic sense of the surgical outcome. Stating and
restating the specific care and likely result throughout the screening process serves to reduce
possible misunderstanding and disappointment.
Screening Suggestions
Assign a translator to a nurse, an in-country volunteer or the speech/dental
team members at the end of the screening process to inquire specifically if
patients and families understood the screening process. It is also important
that they understand the possible surgery that will be performed and
when/how they will be notified if they are selected for surgery.
Arrange for medical team members to be available at the notification site to
address the needs of patients/families that have been chosen as well as
those that have not been chosen for the surgery schedule. Have patient
charts available to answer specific questions from patients and families.
Screening Priorities
Priority 1: Primary Repair of Cleft Lip—All Ages
This procedure can be accomplished safely, quickly and with near-guarantee of
vastly improved appearance and the restoration of a normal face and smile.
The mission team should complete all primary lip cases that are healthy
enough for surgery. The safe minimum age and body weight of the patient
depends on the setting, equipment and experience level of the anesthesia
staff and the safety of the recovery room and surgical floor setting.
Priority 2: Primary Repair of Cleft Palate—Ages 1-6
These cases have the greatest success in enabling the patient to develop normal
speech. The operation can be done safely in most children over 12 months.
The younger the patient, the better the chance of developing normal speech,
even when no speech therapy is available in the country.
Priority 3: Primary Repair of Cleft Palates—Ages 6-Adult
When possible, older children and adults will have the opportunity for reconstruction.
While perfect speech is not likely, a great deal of improvement
can be achieved safely and in a short period of time. Additionally, the psychology
benefits to the patient are enormous. These patients will require
good follow-up and must be told that additional surgery may be necessary.
Primary pharyngeoplasties in conjunction with palatoplasties may be beneficial
in this patient population.
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