Abstract
Objective To describe the presentation and surgical care of patients managed for cleft lips and palates during a surgical outreach program.. Study design A five year retrospective chart study of the patients operated on between January 2005 to the 31st December 2009 in selected hospitals in Kenya. Setting Smile train-facilitated surgical outreach programs at the following hospitals: St Elizabeth Mission Hospital Mukumu, St Francis Mission Hospital, Mwiki, Embu Provincial General hospital , Isiolo District Hospital.and Alupe Subdistrict Hospital. Subjects One hundred and sixty three patients with cleft lips and palates. Results The male female ratio was 1.3 to 1. Left unilateral cleft lip was the most common malformation (34.6% of the patients) with modified Millards repair the most frequent surgical procedure. More than 30% of the patients operated on had attained their fifth birthday. There were eight complications for every 100 procedures. Palatal fistulae were the most common complications. Conclusion The overall pattern of deformity encountered and the morbidity profile correlate with other studies. There is need to intensify more outreach programs to capture younger patients and address the backlog of cleft cases in the community.
Highlights
Cleft lips and palates are common congenital malformations with variable prevalences
The ideal treatment of cleft lip and palate involves a multidisciplinary team approach, comprising plastic surgeons, maxillofacial surgeons, speech pathologists, otolaryngologists, among others (3,4) This treatment would involve multiple stages of surgeries and revisits commencing from neonatal life to early adulthood
The hospital staff mobilize the patients as well as oversee the postoperative care once the outreach team leaves the site.The local team ensures proper documentation and follow up for the patients The authors have been involved in the “Smile Train” outreach program for the last five years
Summary
Data on 163 patients out of a total of 186 patients operated on during the study period were analyzed. The male to female ratio for the patients was 1.3 to 1.The age range was 2.5 months to 28 years with a mean age of 4.8 years. The modal age range was [6-9] months. A total of 187 defects in 163 patients were recorded. Left unilateral cleft lip comprised 36.4 percent of the defects while bilateral cleft lips were 18.7 percent of the defects (table 2). Modified Millard’s repair was used for all the unilateral cleft lips while the Manchester repair was the technique for the majority of bilateral cleft lips. Unipedicle mucoperiosteal flaps were most commonly used surgical procedures for the cleft palate (table 3). There were 14 complications following 177 procedures (Table 4). Half of the complications were palatal fistulae encountered in seven of 28 patients who underwent repairs for complete cleft palates
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