CPM Winter 2020 - 17

daup h i n c m s .o rg

FROM L TO R: Dr. Lighthall performing surgery to repair a cleft palate at one of the local underserved hospitals in Peru. They return to the same location every year so there
is long term follow up with their patients. In this photo, local surgeons, medical students, and nursing students are learning how to take care of this underserved population of patients.
FACES Foundation team members work closely with local Lions clubs to help provide lodging, transportation, food, and emotional support to the patients and their families.

B

illions of people worldwide, especially mission trips. Cleft lip and palate surgery with, in order to help treat cleft lip and palate.
in low and middle income countries, can be performed by either plastic surgeons, These include, but are not limited to, Operlack basic access to surgical services. facial plastic surgeons, or otolaryngologists.
ation Smile, FACES Foundation, and Smile
This is often due to location, lack
Train.
These groups organize mission trips that
An unfixed cleft lip and palate can cause
of resources and technology, financial issues, feeding issues in infants, leading to difficulties help thousands of cleft lip and palate patients
or a shortage in surgical personnel in the in growth and gaining weight. Infants with each year. In recent years, these organizations
country. The global burden of surgical disease cleft lip and palate face serious social stigma have focused on making these short surgical
can be defined as the mortality and disability and appearance deformities. This can make trips more sustainable by empowering the local
caused by major diseases that can be treated it difficult to integrate into society, and cause communities and training in-country health
surgically. In 2015, it was estimated that the patients to be excluded from their communities. professionals.4 Such efforts can only help to
global surgical burden was 30% of the global This impacts educational and employment further close the gap between surgical access
disease burden.1 Clearly there is an unmet opportunities, ultimately decreasing quality of in high- and low-income countries.
need for global surgery that must be addressed. life. Cleft lip and palate can also cause speech
Cleft palate surgeries are cost-effective and
Previously, surgery was thought to be a problems and hearing loss if left untreated.3 Pa- have a significant impact on the health of a
complex, expensive and non-sustainable tients will also have significant nasal deformities patient. Plastic surgery and otolaryngologyintervention. Therefore, global health efforts that cause difficulty breathing through their head and neck surgery have an important
were focused more on medical treatments nose. Typically, children will need multiple role to play in improving global health.
and disease prevention. However, it has been surgeries throughout their lifetime.
Raising awareness of the global surgical
shown that certain surgical interventions,
It is recommended that children born with burden and encouraging more surgeons
such as cleft lip and palate surgery, have cleft lip and palate are treated within the first to participate in international outreach
economic advantages, can be life-changing, year of life. This early treatment helps to negate could help to further decrease disparities
and are sustainable.
facial deformities and improve feeding and and allow more people access to quality
A cleft lip occurs when tissue that makes up speech problems later in life. For people living and safe healthcare worldwide.
the lip does not completely join before birth,
resulting in a hole in the upper lip. Similarly, a
cleft palate occurs when the tissues that make
the roof of the mouth do not join together
before birth. This leaves a hole in the roof of
the baby's mouth. It is possible for a child to
be born with a cleft lip, a cleft palate, or both.

Cleft lip, cleft palate, or a combination of
the two are said to occur in 1 out of every
700 births,2 and present a large health burden around the world. It is one of the most
common birth abnormalities, and one of the
most visible. Often, treatment requires one
or two surgeries, and needs little follow up.
This makes it an ideal surgery for medical

in low-and-middle-income countries, this
surgical intervention may not occur until after
this optimal time period. Sometimes it will
not be fixed at all. Barriers to treatment in lowand middle-income countries include travel
costs to the hospital, which can be located
very far from the patient's community, lack
of access to a surgeon, or lack of awareness of
the treatment. Cleft lip and palate surgery is
a cost-effective and curative intervention that
can significantly impact a patient's function
and quality of life.4

REFERENCES
1. Shrime MG, Bickler SW, Alkire BC, Mock C. Global
burden of surgical disease: an estimation from the provider
perspective. The Lancet Global Health. 2015 Apr 27;3:S8-9.
2. Massenburg BB, Jenny HE, Saluja S, Meara JG, Shrime
MG, Alonso N. Barriers to cleft lip and palate repair
around the world. Journal of Craniofacial Surgery. 2016
Oct 1;27(7):1741-5.
3. Semer NB, Sullivan SR, Meara JG. Plastic surgery and
global health: how plastic surgery impacts the global burden of
surgical disease. Journal of Plastic, Reconstructive & Aesthetic
Surgery. 2010 Aug 1;63(8):1244-8.
4. Borrelli MR. What Is the Role of Plastic Surgery in Global
Health? A Review. World journal of plastic surgery. 2018
Sep;7(3):275.

In order to help overcome these barriers,
multiple organizations have been set up for
surgeons and medical professionals to volunteer
Central PA Medicine Winter 2020 17


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CPM Winter 2020

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