S4A-25 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I INTERNATIONAL ESTABLISHMENT OF CRANIOFACIAL PROGRAM: 15 YEARS IN THE REPUBLIC OF MOLDOVA

Abstract

Introduction: The prevalence of craniosynostosis is estimated to be 1 in 2100 births in the US. The global prevalence is unknown due to a lack of recognition, limited technology for diagnosis, and limited resources for treatment. Moldova, a country of 2.8 million people. The infrastructure for surgical treatment of craniosynostosis in Moldova was non-existent in 2003. Given the clear need and lack of alternatives, we will describe a replicable pathway to develop local surgical care for craniofacial patients through education and training. Methods: A bilateral state partnership for collaboration began between North Carolina and Moldova in 1999. This facilitated the beginning of our relationship in 2003 between the surgical departments of our Universities. Stake holders were identified and jointly committed to the establishment of a program. Yearly surgical educational exchanges were conducted. A local team was established including pediatric oral maxillofacial surgeons, neurologists, pediatricians, dentists, neurosurgeons, and anesthesiologists. Data was collected from 2011 to 2018 on more than 33 patients who underwent surgical intervention from the joint team. The patients were assessed including gender, age, blood loss, blood transfusion, duration of surgery, complications, cephalic index (CI), length of stay, and cost. Additional patients treated by the Moldova team were also monitored for the same outcome parameters. Results: Surgical intervention began with minimally invasive surgery utilizing springs for treatment of sagittal synostosis. This allowed the local team to provide time sensitive surgery with limited resources. As the team built confidence and resources were added, complete cranial vault surgery was successfully performed. The joint cases included treatment of metopic (6), sagittal (13), unicoronal (9), bicoronal (4) and multi-suture (1) synostosis. There were no significant complications during the follow-up period. For the past several years the Moldova team has been independently treating a wide range of craniofacial deformities with minimal morbidity and excellent aesthetic outcomes. Conclusion: Organizations desiring to develop craniofacial programs should begin with establishing relationships at the local level. A commitment is needed to build trust among the physicians, administrators and patients. Financial resources are helpful to provide the needed educational exchange programs and equipment needed for the perioperative care of the patients. Significantly more patients can receive needed and life-saving surgical care in their own country when there is a dedicated local team trained to provide the surgery.