Plastic Surgery Research Council
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Presenter: Julia C Conway, BA
Co-Authors: Jabs EW; Oberoi K; Doucette J; Taub PJ
Mount Sinai School of Medicine

BACKGROUND: Surgical correction of orofacial clefts greatly mitigates negative outcomes. However, access to reconstructive surgery is limited in developing countries. An international surgical charity (Smile Train) empowers local medical professionals to provide free cleft treatment. The present study reviews epidemiological data from the organization s database in 33 African countries from 2001-2012.

METHODS: Data from questionnaires completed by individual surgeons who performed cleft care in each of the African countries within the Smile Train program were reviewed. The results were analyzed for comparison with previously reported data.

RESULTS: Questionnaires were completed for 36,384 patients by 389 surgeons. The distribution of clefts was: 36.7% cleft lip (CL), 12.3% cleft palate alone (CP), and 51.0% cleft lip and palate (CLP). The male: female ratio was 1.45:1, and the unilateral: bilateral ratio 3.4:1, with left-sided predominance 1.6:1. 4.43% of patients had associated anomalies. The most frequent surgeries included 67.5% primary lip/nose unilateral repair and 12.3% primary cleft palate repair. The reported complication rate was 1.9%. The average age at surgery was 9.55-years, and the average hospital stay was 4.5 days.

CONCLUSION: This is the largest reported series of cleft patients from the African continent. Distribution of gender and cleft type coincides with Caucasian epidemiologic reports of 25% CL, 25% CP, and 50% CLP1, 2:1 unilateral:bilateral and left:right ratios, and male predominance. Fewer than expected patients, especially females, presented with isolated cleft palates, suggesting either less opportunity to repair palatal clefts, or that visual problems outweigh functional concerns. Fewer than expected associated anomalies suggests true ethnic variation, or that more severely-affected patients are not presenting for treatment. Previous studies on African cleft epidemiology vary widely, emphasizing this cohort s substantial contribution.

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