Craniofacial surgeons around the world are striving toward a critical goal: making high-quality cleft palate and craniofacial reconstructive surgical services available to children in developing countries. An update on the state-of-the-art in cleft and craniofacial care-presented at last year's fifth Congress of the International Cleft Lip and Palate Foundation, sponsored by the World Craniofacial Foundation (WCF)-is published in a special supplement to The Journal of Craniofacial Surgery, under the editorship of Mutaz B. Habal, MD, FRCSC. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

With "The Passion for Excellence" as its theme, the Congress was dedicated to improving the delivery of care in cleft and craniofacial surgery in the developing world. Although the challenges are many, "The answer lies in a multifaceted approach to this complex global problem," writes Dr. Kenneth E. Salyer of the WCF in an introductory essay.

Progress Requires 'Evidence-Based, Collaborative Research'

Dr. Salyer reviews highlights from the Congress, which was attended by hundreds surgeons and other professionals from 45 countries around the world. "This was truly an international meeting that was extremely successful from the viewpoint of sharing knowledge and developing new relationships globally," he writes. The special supplement of JCS includes more than 60 articles, editorials, and discussions from the Congress.

The presentations cover a wide range of topics related to improving the delivery of care in cleft and craniofacial surgery-supported by multidisciplinary teams-in developing countries. More than half a million children are born each year with craniofacial and clefting abnormalities, but only a "lucky few" receive long-term excellent care until they are fully grown, according to Dr. Salyer. Even in the United States, where multidisciplinary care for cleft palate patients began, the "broken health system" has led to fragmentation of care and lack of needed follow-up for many patients.

Evidence-based collaborative research is essential to define the best techniques and approaches to cleft palate and craniofacial surgery. Research has clearly shown that a certain amount of experience-at least 20 cases per year per surgeon-is essential to achieve excellent results. But the lack of training opportunities and hands-on experience is a major challenge to extending cleft palate care to developing countries. "One of my personal observations is that educational programs in many developing countries do not exist," Dr. Salyer writes.

WCF Leads Efforts to Build Training Programs in Developing World

Remarkable progress has been made in the scientific understanding and surgical skill needed to correct most congenital deformities, allowing affected infants to lead a normal life. But Dr. Salyer asks, "What is progress? If it is available for only a minority of the world's population, then we cannot be satisfied." Programs like Smile Train-a major sponsor of the International Cleft Lip and Palate Foundation Congress-send surgical teams to poor countries to perform operations. However, the long-term solution is to establish dedicated interdisciplinary craniofacial teams and centers in the developing world.

To meet this goal, the WCF is working with centers around the world to "initiate, augment, expand, improve, and elevate" the ability to provide interdisciplinary craniofacial care in countries around the world. The WCF has partnered with centers in Argentina, China, India, Libya, Mexico, Oman, the Philippines, South Africa, and Thailand, with the goal of providing "sustainable educational programs for training the next generation of professionals."

The success of this approach is illustrated by the development of a world-class craniofacial surgery program at Chang Gung Hospital in Taipei, which now supports the provision of excellent care throughout Asia. Articles in the JCS supplement report on the current status of cleft lip and palate care in China, and on strategies for building new craniofacial centers in other countries. Dr. Salyer concludes, "This model should stand as an example of what can be done in other parts of the developing world and serves as a guiding light for our team and our vision at the WCF."

About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

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