1
|
Reddy NK, Shah ND, Weissman JP, Chwa ES, Gosain AK. Evaluation of Global Cleft Care Initiatives Among the Top Searched Low- and Middle-Income Countries. Cleft Palate Craniofac J 2024; 61:1220-1227. [PMID: 36866656 DOI: 10.1177/10556656231160399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE International outreach for cleft lip and/or palate care has traditionally been characterized by foreign groups and individuals holding surgical outreach trips in low- and middle-income countries. However, this "magic bullet" approach has often been criticized for prioritizing short-term results that may disrupt local workflow. The presence and impact of local organizations that support cleft care and take on capacity building initiatives has not been well explored. DESIGN Eight countries previously studied as having the highest Google search demand for CL/P were chosen for the scope of the study. Local NGOs in regions were identified through a web search, and information was collected regarding the location, objectives, partnerships, and work conducted thus far. RESULTS Countries with a strong combination of local and international organizations included Ghana, Philippines, Nepal, Kenya, Pakistan, India, and Nigeria. The country with minimal to no local NGO presence included Zimbabwe. Local NGOs often supported education and research, training of providers and staff, spreading community awareness, offering interdisciplinary care, and opening cleft clinics and hospitals. Unique initiatives included starting the first school for children with CL/P, enrolling patients in the national healthcare to cover CL/P care, and monitoring the referral system to improve efficiencies in the healthcare system. CONCLUSIONS Moving towards a mindset of capacity building not only involves bilateral partnerships between international host sites and visiting organizations, but also collaboration with local NGOs that have a deep understanding of local communities. Successful partnerships may help address the complex challenges regarding CL/P care faced by LMICs.
Collapse
Affiliation(s)
- Narainsai K Reddy
- Texas A&M School of Medicine, Engineering Medicine (EnMed), Houston, Texas, USA
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Joshua P Weissman
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| |
Collapse
|
2
|
Fu ML, Aldosari M, Chakraborty A, Ko J, Tahir P, Oberoi S. The Effects of Presurgical Orthodontic Treatment on the Outcome of Secondary Bone Graft for Individuals With Cleft Lip and Palate. J Craniofac Surg 2024:00001665-990000000-01742. [PMID: 38949493 DOI: 10.1097/scs.0000000000010431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND/OBJECTIVE Alveolar bone graft (ABG) or repair has become a routine part of treatment protocols for individuals with cleft lip and/or palate. However, the necessity and potential benefits of presurgical orthodontic treatment in influencing the outcomes of secondary alveolar bone grafting remain inconclusive. This systematic review aimed to assess the impact of presurgical orthodontics on preparing patients for secondary alveolar bone grafts. STUDY DESIGN The authors systematically searched for relevant articles in PubMed, Web of Science, and Embase databases spanning the period from January 1, 2000, to December 31, 2023, using keywords related to alveolar bone grafting and orthodontic treatment for patients with cleft lip and/or palate. The review encompassed various study designs, including prospective and retrospective studies, observational studies, cross-sectional studies, randomized and nonrandomized clinical trials, cohort studies, and case-control studies. The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the risk of bias was evaluated in studies selected for full-text review. RESULTS The search strategy identified 809 publications. After initial screening and application of exclusion criteria, 11 studies were included for final review. Three were prospective studies, 8 were retrospective studies, and 3 were cross-sectional cohort studies. On the basis of ROBINS-I and RoB 2 risk assessment, 9 studies were found to be of moderate risk of bias, one study was categorized as of high risk of bias, and 1 study was categorized as low risk of bias. CONCLUSIONS Drawing from the latest and most reliable studies, 7 out of 11 included studies provided compelling evidence that presurgical orthodontics preceding alveolar bone grafting (ABG) leads to significantly improved outcomes compared with cases without presurgical orthodontic intervention. Notably, individuals with specific conditions, such as severely collapsed upper arch and mispositioned upper incisors, appear to derive the greatest benefits from presurgical orthodontic treatment. However, a call for additional studies characterized by high methodological quality and with longer follow-up periods is emphasized to enhance the safety considerations for both practitioners and patients concerning the utilization of presurgical orthodontics in the treatment of individuals with cleft lip and palate.
Collapse
Affiliation(s)
| | - Malak Aldosari
- Department of Orofacial Sciences and Orthodontics, Division of Craniofacial Anomalies, School of Dentistry, University of California, San Francisco, CA
| | - Archak Chakraborty
- School of Dentistry, UT Health Science Center San Antonio, San Antonio, TX
| | - Jaemin Ko
- Department of Craniofacial and Special Care Orthodontics, Division of Dentistry, Children's Hospital Los Angeles, Los Angeles
| | - Peggy Tahir
- Education and Research Services, UCSF Library, University of California, San Francisco, CA
| | - Snehlata Oberoi
- Department of Orofacial Sciences and Orthodontics, Division of Craniofacial Anomalies, School of Dentistry, University of California, San Francisco, CA
| |
Collapse
|
3
|
Eo MY, Thi Hoang Nguyen T, Amponsah EK, Sodnom-Ish B, Frimpong P, Yang HJ, Kim SM. Remote Real-Time Training for Sustainable Cleft Operation in Rural Region of West Africa: Effective Webinar in the COVID-19 Pandemic. J Craniofac Surg 2023:00001665-990000000-01097. [PMID: 37750711 DOI: 10.1097/scs.0000000000009759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/04/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION The surgical requirement for cleft lip and palate repair remains unmet in many developing areas of the world, including remote regions of Ghana. This article reviews the utilization of Internet education and online consultation for cleft lip and palate surgical training in Sunyani Regional Hospital (SRH), Ghana. METHODS The cleft lip and palate treatment was promoted to patients in remote areas of Sunyani, Ghana region, through a charitable outreach program. These basic designs and settings were managed by local participants such as doctors, residents, nurses, and staff in SRH, Ghana. RESULTS From November 2014 to December 2020, the authors collaborated in surgical treatment for 84 cases that were diagnosed with unilateral cleft lip, bilateral cleft lip, hard and soft palate cleft, and microstomia. The type of surgery has varied and has included cheiloplasty, palatoplasty, and others. The average scores of esthetic outcome evaluation were nasal form=2.4, symmetry of the nose=2.9, and vermillion border=2.9. Through the program, the surgeons and residents became significantly more proficient at cleft lip and palate surgery. The seminar topics have covered essential and sustainable topics based on SRH's current needs and showed the effectiveness in the current coronavirus disease-19 pandemic situation. CONCLUSIONS The shortage of orofacial cleft surgeons working in rural areas like Sunyani, Ghana, remains an obstacle that poses a challenge to any effort to improve health care quality in these rural communities. Sustainable remote education is essential for the training of local cleft surgeons to fill this local need; our collaborative and charitable program could be a recommended education design for cleft surgeons and institutes for their sustainable education.
Collapse
Affiliation(s)
- Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Truc Thi Hoang Nguyen
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Emmanuel K Amponsah
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, Sunyani, Ghana
| | - Buyanbileg Sodnom-Ish
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Paul Frimpong
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, Sunyani, Ghana
| | - Hoon Joo Yang
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, Sunyani, Ghana
| |
Collapse
|
4
|
Leversedge C, McCullough M, Appiani LMC, Đình MP, Kamal RN, Shapiro LM. Capacity Building During Short-Term Surgical Outreach Trips: A Review of What Guidelines Exist. World J Surg 2023; 47:50-60. [PMID: 36210361 PMCID: PMC9726663 DOI: 10.1007/s00268-022-06760-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION While short-term surgical outreach trips improve access to care in low- and middle-income countries (LMIC), there is rising concern about their long-term impact. In response, many organizations seek to incorporate capacity building programs into their outreach efforts to help strengthen local health systems. Although leading organizations, like the World Health Organization (WHO), advocate for this approach, uniform guidelines are absent. METHODS We performed a systematic review, using search terms pertaining to capacity building guidelines during short-term surgical outreach trips. We extracted information on authorship, guideline development methodology, and guidelines relating to capacity building. Guidelines were classified according to the Global-QUEST framework, which outlines seven domains of capacity building on surgical outreach trips. Guideline development methodology frequencies and domain classifications frequencies were calculated; subsequently, guidelines were aggregated to develop a core guideline for each domain. RESULTS A total of 35 studies were included. Over 200 individual guidelines were extracted, spanning all seven framework domains. Guidelines were most frequently classified into Coordination and Community Impact domains and least frequently into the Finance domain. Less than half (46%) of studies collaborated with local communities to design the guidelines. Instead, guidelines were predominantly developed through author trip experience. CONCLUSION As short-term surgical trips increase, further work is needed to standardize guidelines, create actionable steps, and promote collaborations in order to promote accountability during short-term surgical outreach trips.
Collapse
Affiliation(s)
- Chelsea Leversedge
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA USA
| | - Meghan McCullough
- Department of Plastic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA USA
| | - Luis Miguel Castro Appiani
- Department of Orthopaedic Surgery, Hospital Clinica Biblica, Aveinda 14 Calle 1 Y Central, San José, Costa Rica
| | - Mùng Phan Đình
- Orthropaedic Institute, 175 Military Hospital, Ho Chi Minh City, Vietnam
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA USA
| | - Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California, 1500 Owens St., San Francisco, CA USA
| |
Collapse
|
5
|
Chahine EM, Ramly EP, Marston AP, Teng SN, Nader M, Kassam SN, Kantar RS, Hamdan US. Quality Assurance Standards for Outreach Cleft Lip and Cleft Palate Repair Programs in Low-Resource Settings. Cleft Palate Craniofac J 2022; 60:773-779. [PMID: 35179415 DOI: 10.1177/10556656221074883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Comprehensive cleft care is a multidisciplinary team endeavor. While untreated craniofacial conditions have multiple undue repercussions, cleft care in outreach settings can be fraught with significant perioperative morbidity risks. AIM Propose updated quality assurance standards addressing logistic and operational considerations essential for the delivery of safe and effective cleft lip and /or palate (CL/P) care in low and middle-income countries (LMICs) settings. METHODS Based on American Cleft Palate-Craniofacial Association (ACPA) quality standards, published literature, published protocols by Global Smile Foundation (GSF), and the senior author's three-decade experience, updated standards for outreach cleft care were synthesized. RESULTS Ten axes for safe, effective, and sustainable cleft lip and palate care delivery in underserved settings were generated: 1) site assessment, 2) establishment of community partnerships, 3) team composition and credentialing, 4) team training and mission preparation, 5) implementation of quality assurance guidelines, operative safety checklists, and emergency response protocols, 6) immediate and long-term postoperative care, 7) medical record keeping, 8) outcomes evaluation, 9) education, and 10) capacity building and sustainability. Subsequent analysis further characterized essential components of each of those ten axes to delineate experience derived and evidence-based recommendations. DISCUSSION Quality assurance guidelines are essential for the safe delivery of comprehensive cleft care to patients with CL/P in any setting. Properly designed surgical outreach programs relying on honest community partnerships can be effectively used as vehicles for local capacity building and the establishment of sustainable cleft care ecosystems.
Collapse
Affiliation(s)
| | - Elie P Ramly
- Global Smile Foundation, Norwood, MA, USA.,6684Oregon Health & Science University, Portland, OR, USA
| | | | | | - Marie Nader
- Global Smile Foundation, Norwood, MA, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Serena N Kassam
- Global Smile Foundation, Norwood, MA, USA.,New York University College of Dentistry, New York, NY, USA.,21668The University of Maryland Medical System, Baltimore, MD, USA
| | - Rami S Kantar
- Global Smile Foundation, Norwood, MA, USA.,21668The University of Maryland Medical System, Baltimore, MD, USA
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA.,12261Tufts University School of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
6
|
Fell M, Goldwasser M, Jayanth BS, Pereira RMR, Nawej CT, Winer R, Daftari N, Brewster H, Goldschmied K, Almas CF, Eshete M, Galiwango GW, Hollier LH, Hussain A, Lo LJ, Salins P, Sell D, Tafase A, Zuker RM. Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations. Cleft Palate Craniofac J 2022; 60:526-535. [PMID: 34982012 PMCID: PMC10102820 DOI: 10.1177/10556656211069827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptations to cleft care protocols during and after COVID-19 as a priority learning area of need. A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptations to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organizations involved in comprehensive cleft care. 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 scrutinized and COVID-19 adaptations, specifically in the pre- and perioperative periods, were highlighted. Second, surgical procedures and cleft care services were prioritized according to their relationship to functional outcomes and time-sensitivity. The surgical procedures assigned the highest priority were emergent interventions for breathing and nutritional requirements and primary palatoplasty. The cleft care services assigned the highest priority were new-born assessments, pediatric support for children with syndromes, management of acute dental or auditory infections and speech pathology intervention. 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.
Collapse
Affiliation(s)
- Matthew Fell
- CLEFT Charity, Chelmsford, UK.,Cleft Collective, University of Bristol, Bristol, UK
| | - Michael Goldwasser
- Operation Smile, Virginia Beach, USA.,Craniofacial and Surgical Care, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Rui Manuel Rodrigues Pereira
- Faculdade de Medicina da Universidade de Sao Paulo, Sau Paulo, Brazil.,Instituto de Medicina Integral Prof Fernando Figueira, Recife, Brazil
| | | | | | | | | | - Karen Goldschmied
- Craniofacial and Surgical Care, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | | | - Mekonen Eshete
- Cleft Lip and Palate Program, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Larry H Hollier
- Smile Train Global Medical Advisory Board, New York, USA.,Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA
| | - Akhter Hussain
- ABMSS, Bengaluru, India.,Yenepoya Dental College, Karnataka, India
| | - Lun-Jou Lo
- Noordhoff Craniofacial Foundation, Taipei, Taiwan.,Craniofacial Center, Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Paul Salins
- ABMSS, Bengaluru, India.,Mazumdar Shaw Medical Centre, Karnataka, India
| | - Debbie Sell
- Great Ormond Street Hospital for Children, London, UK
| | - Amanuel Tafase
- Project Harar, London United Kingdom and Addis Ababa, Ethiopia
| | - Ronald M Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Canada.,The University of Toronto, Toronto, Canada
| |
Collapse
|
7
|
Chahine EM, Shah ND, Al Abyad OS, Vyas RM, Hamdan US. Emergency Response Protocols for Overseas Outreach Settings: Global Smile Foundation Strategy. Cleft Palate Craniofac J 2021; 59:1086-1091. [PMID: 34636659 DOI: 10.1177/10556656211049998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-governmental organizations (NGOs) aim to alleviate unmet global disease burden and promote collaboration between visiting and host countries. Well-executed emergency response protocols are foundational to providing safe and quality care in an unpredictable global setting. Global Smile Foundation (GSF) instituted a protocol in 2012 based on over three decades of cleft care experience. Here, we update this protocol and provide information on how to address special circumstances such as humanitarian crises and disease outbreaks. The GSF response protocol was developed in conjunction with surgeons, anesthesiologists, nurses, and administrators to ensure all team members are adequately prepared to respond to emergency situations in global outreach. This protocol provides information on pre-departure preparation, onsite setup, operative precautions, and post-departure debriefings. Emphasis is placed on a standardized, reproducible workflow that accounts for necessary site-specific adjustments. Strategies include emergency simulations, site-specific safety checklists, standardized operating room protocols, and well-defined individual responsibilities. The authors also provide anticipatory guidance in addressing unexpected circumstances, such as disease outbreak and natural disaster, during global outreach. In conclusion, a proactive and systematic approach to emergency response and prevention is vital to minimizing morbidity and mortality during surgical outreach initiatives. The GSF protocol represents a reproducible approach that other organizations can adopt and adapt to their unique needs.
Collapse
Affiliation(s)
| | - Nikhil D Shah
- 12244Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Raj M Vyas
- Department of Plastic Surgery, 8788University of California Irvine, Irvine, California, USA
| | | |
Collapse
|
8
|
Clinical Practice Guidelines for the Management of Patients With Cleft Lip and Palate: A Systematic Quality Appraisal Using the Appraisal of Guidelines for Research and Evaluation II Instrument. J Craniofac Surg 2021; 33:449-452. [PMID: 34545056 DOI: 10.1097/scs.0000000000008155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
ABSTRACT Patients with cleft lip and/or palate require complex and longitudinal care by a multidisciplinary cleft team. Unfortunately, delivery of cleft care is often fragmented, and care practices can vary significantly. Multiple clinical practice guidelines (CPGs) have been proposed to provide a standardized framework for cleft care delivery. As CPGs have gained popularity, there has been increasing demand to maintain the quality of existing guidelines. A comprehensive search of EMBASE, MEDLINE via PubMed, Scopus, Cochrane and grey literature sources published from January 1, 1990 to December 31, 2020 was conducted to identify CPGs for the care of cleft patients. The Appraisal of Guidelines for Research and Evaluation, 2nd edition II tool was used to assess the quality of selected CPGs. Intraclass coefficients were calculated to assess agreement among appraisers. Eleven guidelines were identified for study inclusion. One guideline was classified as "high" quality by Appraisal of Guidelines for Research and Evaluation II criteria, and the remaining guidelines were classified as "average" or "low" quality. The "Clarity of Presentation" domain achieved the highest mean score (76.9% ± 11.7%) across CPGs, whereas the "Rigor of Development" domain scored the lowest (35.6% ± 21.2%). Intraclass coefficients analysis reflected very good inter-rater reliability across all domains (0.853-0.987). These findings highlight significant variability in the quality of existing CPGs for the global management of patients with cleft lip and/or palate. The "Rigor of Development" domain reflects the greatest opportunity for improvement. Given these findings, future guidelines may prioritize incorporating a systematic review of existing evidence into recommendations.
Collapse
|
9
|
Chahine EM, Kantar RS, Kassam SN, Vyas RM, Ghotmi LH, Haddad AG, Hamdan US. Sustainable Cleft Care: A Comprehensive Model Based on the Global Smile Foundation Experience. Cleft Palate Craniofac J 2020; 58:647-652. [PMID: 32914647 DOI: 10.1177/1055665620957531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clefts of the lip and palate are leading congenital facial anomalies. Underserved patients with these facial differences lack access to medical care, surgical expertise, prenatal care, or psychological support. Moreover, the disease results in significant economic strains on patients and their families. While surgical outreach programs have attempted to fill this void, significant challenges facing international comprehensive cleft care persist. OBJECTIVE Propose a path toward international sustainable cleft care based on the Global Smile Foundation experience. RESULTS International sustainable comprehensive cleft care can be achieved by regulating surgical outreach programs. Regulation of these missions would ensure standardized care and encourage stakeholders to cooperate and adequately allocate funding and resources. Capacity building can be achieved through "diagonal" cleft care delivery models, multidisciplinary workshops, fellowship programs, research and quality assurance, as well as leveraging emerging technologies such as Augmented Reality. CONCLUSION International comprehensive cleft care requires continuous collaborative efforts between visiting and local teams as well as international and national organizations. Standardizing and regulating current practices as well as promoting capacity building initiatives can contribute to sustainable cleft care.
Collapse
Affiliation(s)
| | - Rami S Kantar
- Global Smile Foundation, Norwood, MA, USA.,Department of Surgery, 21688University of Maryland Medical System, Baltimore, USA
| | - Serena N Kassam
- Dental and Pre-Surgical Division, Global Smile Foundation, Norwood, MA, USA.,Department of Pediatric Dentistry, New York University College of Dentistry, New York, NY, USA.,Division of Pediatric Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatric Dentistry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Raj M Vyas
- Department of Plastic Surgery, 8788University of California Irvine, Irvine, CA, USA
| | | | - Anthony G Haddad
- Global Smile Foundation, Norwood, MA, USA.,Department of Surgery, Brigham and Women's Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA.,Otolaryngology, Tufts University School of Medicine, Boston, MA, USA.,Otology and Laryngology, Harvard Medical School, Boston, MA, USA.,Otolaryngology, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|