Cleft Lip and Palate Repairs in Togo, “Sourire de l’Espoir” Humanitarian Missions’ Experience: A Retrospective Study of 201 Consecutive Cases

Abstract

Objective: To describe “Sourire de l’Espoir” humanitarian missions on cleft lip and palate (CLP) repair and how it shaped the future of CLP repair in Togo. _Design_: Retrospective. _Patients_: Clinical files of patients operated on for CLP during humanitarian missions from October 2008 to May 2013 in Lome, the capital of Togo, were reviewed in a nine-month postoperative assessment from June to December 2020. Demographics, clinical, and therapeutic patterns were assessed. We also assessed the Zwisch method used for the training of local surgeons during the missions. Statistical analysis was performed with Epi Info (CDC version 7.1.3.3-2013). _Results_: CLP repair was performed in 201 patients during 10 missions. Patients’ mean age was 7.05 (SD 9.22) years (range: 3 months-50 years); the sex ratio was 1.05. Distribution of cases was as follows: Cleft lip (CL) 109/201 (54.23%); cleft palate (CP) 53/201 (26.23%), and CLP 39/201 (19.40%). The Tennison-Borde-Bedouelle-Malek technique was used for the repair of CL in 119/148 patients (80.41%); the Onizuka technique (modified Millard technique) for the revision surgery of CL in 19 patients previously operated in other settings. The Kriens and Sommerlad palatoplasty technique was performed for primary and revision surgeries for all CP in 89/92 (96.73%) patients. The postoperative course was uneventful in 199/201 (99.00%) patients. One patient presented with an infection on the lip that healed with local wound care, and two patients with palatal fistula were treated by revision surgery. Two patients died in post-operative period. Three surgeons of the local team were trained as per the Zwisch method: in the first two missions, show and tell (60/201 cases), the third and fourth missions, smart help step (48/201 cases); from the seventh mission onwards, passive assistance (51/201 cases) by the local surgeons with no help. _Conclusion_: The “Sourire de l’Espoir” humanitarian missions provided primary and revision surgery to children and adults with CLP while 3 local surgeons were trained to build a local capacity.