Smile Train Research Articles

Sharing to Persuade: The Role of Donor- Versus Charity-Focused Word of Mouth

Charitable organizations are increasingly soliciting donors to engage in word of mouth (WOM) as a strategy to foster future contributions. While some organizations encourage donors to share WOM that focuses on their own donations (donor-focused WOM; e.g., “I just donated to the kids of @StJude. Join me in saving children's lives.”), others prompt donors to share WOM that focuses on the organization itself (charity-focused WOM; e.g., “Smile Train gives children with clefts the #PowerOfASmile.”). Contrary to the common belief that people mostly want to talk about themselves, the current research demonstrates that donor-focused WOM backfires, such that donors are less likely to share donor- than charity-focused WOM. This effect is driven by their belief that donor-focused WOM is less altruistic and is therefore less efficacious in persuading others to contribute to the same cause. In addition to sharing, the type of WOM solicited exerts far-reaching impact, with donor-focused WOM attracting fewer new donors than charity-focused WOM. The current research improves the understanding of WOM type, its effect, and the underlying processes.

Multicenter Pattern of Cleft Surgeries and Factors Associated with Late Primary Cleft Surgery in Nigeria.

This study aimed to analyze multicenter patterns in cleft deformity surgeries and identify factors associated with the timing of primary cleft repair in Nigeria. A cross-sectional study of children managed for clefts from January 2009 to December 2020 at three Smile Train partner tertiary institutions situated in the east (Enugu), west (Ibadan), and northern (Jos) parts of the country using a prospectively collected database. Outcomes were the types of surgery performed, yearly volume of surgeries, methods of repair, and time of surgery (early versus late). Of 1043 cleft surgeries, nearly half (45.7%) involved infants (<12 months). Primary repairs of the lip or palate were performed in 83.4% of cases, with 58.4% for lip repairs and 25.1% for palate repairs. The most common cleft lip repair method was a variant of Millard rotation advancement flap. Over the study years, there was a shift from von Langenbeck palatoplasty to methods such as Bardach's palatoplasty and intravelar veloplasty. Patients with bilateral cleft lip defects were significantly more likely (P < 0.001) to undergo early repairs compared with those with unilateral defects. Late primary cleft lip repairs were significantly (P < 0.001) more common in Enugu. This study highlights the variability in cleft surgery patterns in Nigeria. Late primary cleft surgeries were associated with less severe cleft lip or cleft palate and were more prevalent in Enugu, Southeastern Nigeria. The findings contribute valuable insights for optimizing surgical approaches and resource allocation in the management of cleft deformities in the region.

Virtual Reality Simulation of Airway Management Post-Cleft Palate Surgery: A Model for Sustainable and Equitable Education.

The effectiveness of virtual-reality (VR) simulation-based training in cleft surgery has not been tested. The purpose of this study was to evaluate learners' acceptance of VR simulation in airway management of a pediatric patient post-cleft palate repair. This VR simulation was developed through collaboration between BioDigital and Smile Train. 26 medical students from a single institution completed 10 min of standardized VR training and 5 min of standardized discussion about airway management post-cleft palate repair. They spent 4-8 min in the VR simulation with guidance from a cleft surgery expert. Participants completed pre- and post-surveys evaluating confidence in using VR as an educational tool, understanding of airway management, and opinions on VR in surgical education. Satisfaction was evaluated using a modified Student Evaluation of Educational Quality questionnaire and scored on a 5-point Likert scale. Wilcoxon signed-rank tests were performed to evaluate responses. There was a significant increase in respondents' confidence using VR as an educational tool and understanding of airway management post-cleft palate repair after the simulation (P < .001). Respondents' opinions on incorporating VR in surgical education started high and did not change significantly post-simulation. Participants were satisfied with VR-based simulation and reported it was stimulating (4.31 ± 0.88), increased interest (3.77 ± 1.21), enhanced learning (4.12 ± 1.05), was clear (4.15 ± 0.97), was effective in teaching (4.08 ± 0.81), and would recommend the simulation (4.2 ± 1.04). VR-based simulation can significantly increase learners' confidence and skills in airway management post-cleft palate repair. Learners find VR to be effective and recommend its incorporation in surgical education.

Analysis of the Management of Cleft Lip Surgery with the Characteristics of Patients with Cleft Lips or Without Cleft Palatum in Nort Sumatra

Clefts are the most common type of congenital abnormality on the face. This condition can cause medical, psychological, and social problems in individuals and&#x0D; families. Several previous studies have yielded results in the form of a large number&#x0D; of cleft sufferers who come for treatment at a late age. This can affect the outcomeof the management given. The characteristics of cleft patients in Indonesia, especially in Medan City, are still very limited. Therefore, researchers have the desire to be able to do research in this field. patients with or without cleft palate who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra based on:(1) type of cleft, (2) location of the cleft defect, (3) Gender, (4) Treatment time, and (5) Type of operation. design. The sample for this study was secondary data on 193 cleft patients who were managed by Smile Train Indonesia together with the Horas Sehat Foundation at hospitals in North Sumatra in the 2017 – 2022 period. palate based on the type of cleft was labiognatopalatoschizis with a total of 115 patients (59.6%), based on the location of the defect was a unilateral defect (left side) of 98 patients (50.8%), based on gender was male with a total of 130 patients (67.4%), based on the time of treatment category was the late labioplasty category with a total of 54 patients (28%), and based on the type of surgery the most was the type of primary cleft palate repair surgery with a total of 56 people (29%). from previous studies.

Demographic Profile of Patients with Cleft Lip and Palate Anomaly: 15-year Experience from a Tertiary Care Hospital and Teaching Institute in Wardha District of Maharashtra, India.

Cleft lip and palate (CLP) is considered to be a congenital defect involving the orofacial region. This defect affects the esthetics, speech as well and psychological well-being of a person. The study was performed to analyze the prevalence of different types of cleft deformity reported in a tertiary care hospital which would aid in spreading awareness and thereby reducing the prevalence of this congenital defect. To study the demographic profile of patients with CLP in the Wardha region. A single-center retrospective cross-sectional study was performed. The patients with cleft deformity report under the "Smile Train Project" under the Department of Orthodontics and Dentofacial Orthopedics along with the Department of Oral and Maxillofacial Surgery. The data retrieved included the name of the patient, age, gender, residential address, contact details, and type of cleft. This data was segregated focusing on the gender and type of cleft as per the concern of this study. The datasets were then entered in the Microsoft Excel sheet and the statistical graphical representation was done using Microsoft PowerPoint. In the present study we tried to find out the profile of CLP in the local population. We reported the high prevalence of this orofacial deformity among the population of this area. The data from the present study will help to provide a deeper insight into the burden of CLP anomaly. Based on the data obtained from the present study, future research can be conducted, and cleft-care improvement outcomes can be measured. There are several etiological factors that are responsible for the development of CLP. Also, due to a lack of awareness regarding this, there is an increased prevalence of this defect. In India, due to a lack of knowledge regarding cleft anomaly, poverty, and social stigma, many patients do not report to the hospitals, and hence, there is a need to spread awareness which would encourage people to access the healthcare facilities at an early age and would reduce the complications in later stages. Shivlani VI, Niranjane PP, Diagavane PS, et al. Demographic Profile of Patients with Cleft Lip and Palate Anomaly: 15-year Experience from a Tertiary Care Hospital and Teaching Institute in Wardha District of Maharashtra, India. Int J Clin Pediatr Dent 2023;16(S-3):S278-S282.

Preoperative quality of life of patients with cleft lip and palate in Nigeria: a multicentre cross-sectional pilot study.

the objective of this study was to determine the quality of life (QoL) of the patient with a cleft lip or palate scheduled for surgery. this analytic multicenter cross-sectional study involved six participating Smile Train Partner Hospitals from five geopolitical zones of the country and three major ethnic groups. Patients with cleft lip or cleft palate aged between 8 to 29 years scheduled for repair were recruited. The main outcome measure was quality of life scores as measured by cleft Q. thirty-four (females 18, males 16) patients were scheduled for surgery of either cleft lip n=7 (20.6%) or cleft palate n=27 (79.4). Patients scheduled for primary surgeries were more than those for secondary surgeries, 23 (68.7%) vs 10 (30.3%). Of the QoL scales, the speech distress score was the least (56.0 ± 22.6) and the psychological score highest (73.9 ± 15.8). All QoL mean scores except the psychological score fell below normative cleft Q scores. The psychological scores in males (80.9 ± 16.2) were significantly higher than in females (67.7 ± 12.9, p=0.01). Patients for lip repair had lower psychological scores than those for palatal repair (median=59 vs 73, p=0.01). Patients for palate repair demonstrated significantly lower speech function and distress scores than those for lip repair (p=0.01, p<0.01 respectively). most of the QoL measures in patients with cleft lip and palate in this study fell below normative values. Gender and cleft type affect the quality of life. A larger study is recommended to establish national normative data.

Age at primary surgery among orofacial cleft individuals in Indonesia.

To observe the age at primary cleft surgery among charity organizations such as Smile Train in helping Indonesia manage patients with OFC. A retrospective analysis of medical records was conducted to identify patients with orofacial clefts who underwent primary surgery between 2001 and 2021. The age at the time of surgery was recorded for each patient. Descriptive statistics were used to analyse the data and determine the average age at primary surgery. In the period between 2001 and 2021, a total of 34 239 individuals in Indonesia underwent primary lip surgery, while 16 768 individuals received primary palatal surgery, as recorded in the Smile Train database. Notably, a significant proportion of these surgeries were classified as delayed primary repairs. Approximately 65.3% of primary lip surgeries were performed beyond the recommended timeline of 6 months of age, indicating a delay in the surgical intervention. Similarly, 67% of primary palatal surgeries were also delayed, occurring after the recommended timeline of 18 months of life. This study provides insights into the age at primary surgery among individuals with orofacial clefts in Indonesia. The findings highlight the need for timely intervention and the importance of considering individualized treatment plans based on the specific type of orofacial cleft. Further research is warranted to explore factors influencing the age at primary surgery and their impact on treatment outcomes and long-term functional outcomes in this population.

The Capnography Project.

Capnography is an essential tool used in the monitoring of patients during anesthesia and in critical care which, while required in most high-income countries, is unavailable in many low- and middle-income countries. Launched in 2020, the Smile Train-Lifebox Capnography Project aimed to find a "capnography solution" for resource-poor settings. The project was specifically interested in a capnography device that would meet the needs of the Smile Train partner hospitals to help monitor children requiring airway or cleft surgery. Project advisory and technical groups were formed and included representation from anesthesia practitioners from a balanced representation from all level of income countries, technical experts in capnography, and representatives from the Global Capnography Project (GCAP), the University of California at San Francisco Center for Health Equity in Surgery & Anesthesia (CHESA), and the World Federation of Societies of Anaesthesiologists (WFSA). Built upon the WFSA minimum capnometer specifications, a human centered design approach was used to develop a Target Product Profile. Seven manufacturers submitted 13 devices for consideration and 3 devices were selected for the testing phase. Each of these devices was evaluated for build quality, and clinical and usability performance. Based on the findings from the overall testing process, a combined capnography and pulse oximetry device by Zug Medical Systems was chosen. To accompany the new Smile Train-Lifebox capnograph, an international team of experienced anesthesiologists and educators came together to develop the necessary education materials. These materials were piloted in Ethiopia, subsequently modified, and endorsed by the education team. The device is now ready for distribution, with the accompanying education package, to the Smile Train network and beyond. In addition, a study is being planned to measure the impact of capnography introduction into operating rooms in resource-constrained settings.

Risk Factors Associated with Cleft Etiology: A Multicenter Experience

Background: The etiology of cleft lip and palate is complex and thought to involve genetic influences with variable interactions from environmental factors. Although genetic and environmental triggers are important for syndromic cleft lip and palate, the etiology of the more common non-syndromic (isolated) forms remains poorly understood. Recognition of etiology, risk factors and natural history is essential to define how prevention and treatment should be planned and implemented. Objective: This study is aimed at assessing the possible risk factors in the etiology of patients presenting with cleft lip and palate. Materials and methods: A total of 254 children (children 12years and below) for cleft surgery at three surgical centers (Mercyland orthopedic Hospital, Galaxy Medical Center and shifa Royal Hospital) in the North Eastern under the Smile Train, project for a 2-year period (January 2021 to December 2022) were included in this study. A Self- administered questionnaire was prepared to fill in data about the patients' gender, family history of cleft, consanguineous marriages, maternal risk factors. Ages of the children were ascertained in months and years as told by the parents. Paternal and maternal ages were also recorded. Statistical analysis was done using the Statistical Package for Social Sciences (IBM) 23.0 version. The significant level was set at a p value of \0.05 at 95% confidence interval. Results: Median age at presentation was 4 month, varying from &lt;1 months to 12 years. The gender distribution was 133 (52.4%) males and 121 (47.6%) females (M:F = 1:0.9). Majority (214, 84.3%) of the affected children belonged to low socioeconomic group while only a few (12, 4.7%). High proportion of mothers between the age of 26 to 35 years (42.5%) was observed, but no association was found between maternal age and clefts (p=0.331). There was evidence of association between paternal age &gt;35years old and cleft (p=0.005). Conclusion: This study revealed a strong association between consanguineous marriage, low socioeconomic status and persistent maternal fever during the first trimester and cleft. Increasing paternal age was also found to increase the risk of cleft. The relevance of this study is for public health workers and clinicians to be equipped with adequate information to provide useful counseling to parents particularly those with history of cleft.it may also provide adequate information for policy makers when making policies of public health concerns.

A Surgical Complexity Factor for Clefts of Primary and Secondary Palates.

The surgical treatment of patients with cleft lip and palate depends on the characteristics of the affected anatomical structures (palate, lip and nose). The objective of this work was to develop a quantified classification for these clefts, to represent their surgical complexity. This work was developed with the team of surgeons of the SUMA Cleft Leadership Center (CLC) Smile Train Mexico. The method of Multiple-Criteria Decision Analysis was applied using the Analytic Hierarchy Approach. A surgical complexity factor associated with each cleft was defined and it was validated in a sample of fifty patients treated at the SUMA-CLC.Clinical Relevance- A quantitative classification that represents the surgical complexity of clefts provides an objective unified criteria for planning the surgical treatment of patients, as well as having standardized procedures for the surgical treatment of patients.

Clinical profiles of individuals with orofacial clefts: Results from fourteen Eastern African countries.

BackgroundMore than 100,000 cleft lip and palate patients have benefited from reconstructive surgeries in Africa because of surgical support from non-governmental organizations such as Smile Train. The Smile Train Express is the largest cleft-centered patient registry with over a million records of clinical records, globally. In this study, we reviewed data from the Eastern African patient registry to analyze and understand the clinical profiles of cleft lip and palate patients operated at Smile Train partner hospitals in East Africa. MethodA cross-sectional study design was undertaken through a retrospective database review in fourteen Eastern African countries. The study population included all patients who had cleft lip and palate surgeries recorded in the Smile Train database between 2001 and 2019. Findings86,683 patient records from 14 Eastern African countries were included in this study. The mean age was (8.8), the mean weight was 22.3 kg and 20.8 kg for males and females, respectively, and 61.9% of the surgeries were performed on male patients. Left cleft lip and palate (21,062, 24.62%) and left cleft lip only (17,155, 20.05%) were the most common types of clefts, with bilateral cleft lip only (3958, 4.63%) being the least frequent. complete left cleft lip with complete left alveolus was the most frequent cleft combination observed (n = 21,746) and Cleft lip to cleft lip and palate to cleft palate ratio (CL:CLP: CP) was 4.73:7.1:1. Unilateral primary lip-nose repairs were the most common surgeries (66%). General anesthesia was used for 74,783 (86.2%) of the procedures. InterpretationMost children with cleft lip and/or palate were underweight, possibly due to malnutrition or related to socioeconomic status. There were more male patients compared to females, which could be related to gender disparities. Access to surgical care for children born with congenital defects needs to be improved, and inequities need to be addressed via more evidence-based collaborative intervention strategies. FundingNone

Surgical technique to achieve postoperative alar base symmetry in complete bilateral cleft lip and alveolus repair – A prospective study

ABSTRACT Introduction: Children born with the bilateral cleft lip-cleft palate have a shortened columella and an elevated protruding premaxilla which results in an abnormal appearance of the nose. Materials and Methods: This study was conducted in the Baby MemorialHospital, Calicut, a Smile Train Center in India. After scrutiny, the eligible sample size amounted to30 cases. The patient’s age rangedfrom 4 to 7 months. The basic technique employed is “Veau three straight line repair” technique. This study analyses the importance of a geometrical incision, a back cut extending cephalically above the inferior turbinate at the mucocutaneous junction to elevate the nostril floor, to achieve the symmetry of the alar bases. Result: Preoperative and postoperative anthropometric studies were conducted on the asymmetry and symmetry of the alar bases. The p values for the right side preoperative and postoperative measurement is 0.007 which is highly significant and for the left side, it is &lt;0.001 which also denotes statistical significance of this technique. Conclusion: Further high volume multicentric studies may be suggested since bilateral cases amount for only 10% of the overall incidence of cleft lip cases and even high volume surgeons are privileged to treat only a few. Therefore, it is the obligation of every surgeon who undertakes the care of these children to learn from the past and to analyse results periodically, including comparison with other centres.

Pembuatan dan Pemanfaatan Dashboard Data Rekam Medis Sebagai Alat Bantu Sistem Pendukung Keputusan

The implementation of a hospital management information system at the 'Aisyiyah Padang public hospital opens opportunities for academics to conduct research and experiments. The amount of data stored in the information system database can be used as an alternative for decision making by hospital management, including medical record data for patients who go to the hospital. Existing medical record data can be summarized and presented visually in the form of a dashboard according to the needs of the hospital. Dashboard can provide an overview to management to determine future policies or as a decision support system. This study aims to create a dashboard that can be used as a decision support system. This type of research is descriptive with the subject of medical record data in the database. From the research that has been done, it is found that the number of outpatient patients in 2021 is 23,635 patients. Of this number, the 3 insurers for the most patients were the Badan Penyelenggara Jaminan Sosial (BPJS) with 19,834 patients, Umum with 3,551 patients and Smile Train with 69 patients. For the 3 doctors who treat the most patients, Dr. Lisa Oktamuva, Sp.PD as many as 3284 patients, dr. Yanasta Moendanoe, Sp.OG with 3112 patients, and drg. Harfindo Nismal, Sp.BM as many as 2351 patients. From the research that has been done, it can be concluded that the designed dashboard is still simple and incomplete. From the dashboard it was also found that the person who is responsible for the most patients is BPJS and the doctor who serves the most patients is Dr. Lisa Oktamuva, Sp.PD.)

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Management of orofacial clefts in Africa, insufficient management centers, and workforce.

Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data.

The objective of this study was to use data from Smile Train's global partner hospital network to identify patient characteristics that increase odds of fistula and postoperative speech outcomes. Multi-institution, retrospective review of Smile Train Express database. 1110 Smile Train partner hospitals. 2560 patients. N/A. Fistula occurrence, nasal emission, audible nasal emission with amplification (through a straw or tube) only, nasal rustle/turbulence, consistent nasal emission, consistent nasal emission due to velopharyngeal dysfunction, rating of resonance, rating of intelligibility, recommendation for further velopharyngeal dysfunction assessment, and follow-up velopharyngeal dysfunction surgery. The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 ± 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased velopharyngeal dysfunction and fistula surgery compared to Asian patients. Palatoplasty technique primarily involved one-stage midline repair. Age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train's continual expansion of accessible surgical intervention, nutritional support, and speech-language care.

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study.

Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005). There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

The Evaluation of Hospital Social Responsibility Services in Gatot Soebroto Indonesia Central Army Hospital in 2015 – 2019 of Cleft Lip and Palate Patients

Background : Cleft lip and cleft palate are the most common congenital craniofacial anomalies treated by plastic surgeons. The incidence of cleft lip and palate is higher at lower socioeconomic levels. Hospital Social Responsibility (HSR) in Gatot Soebroto Central Army Hospital provides free cleft lip and palate surgeries to those who need it the most. The HSR services still need to be evaluated, to get an overview of epidemiologic profile of cleft lip and palate patients, and to improve the services itself. Materials and Method: The authors conducted a retrospective descriptive study based on online data of Smile Train HSR RSPAD Cleft Center from period of January 2015 to December 2019. All patients presented with cleft lip and/or palate were included. Results : Of all 713 patients in total; The gender distribution male 62.2% (444/713) was higher than female 37.7% (269/713). Most of the patients came from Java Island 77.5% (553/713). 685 were primary surgeries, 28 secondary surgeries. Among the primary surgeries, lip repair has the highest numbers 71.6% (491/685), followed by palate repair 27.2% (187/685), and alveolar bone grafting 1% (7/685). The most widely used surgical technique in lip surgery was the Millard 50% (345/685), while the most widely used surgical technique in palate surgery was the Bardach technique 22.9% (157/685). The median age for the primary lip repair patients was 1 year (range, 3 months to 60 years), and the median age for the primary palate repair patients was 4 year (range, 7 months to 26 years). Among secondary surgeries, lip revision with Millard technique was the highest (82.1%), followed by scar revision 3.57%, fistula repair (7.1%). The most common diagnosis was unilateral cleft lip (left 34.4%, right 13.2%) and followed by complete cleft palate (22.7%) Conclusion : Male patients were more dominant than females. The most common diagnosis was unilateral cleft lip. Incomplete diagnostic data and clinical photos of patients make it difficult to determine the complete diagnose of cleft lip and palate.

616 Addressing Challenges to Enable Better Use of Routinely Collected Clinical Photographs: Evaluating the Largest Cleft Dataset for Machine Learning Analysis

Abstract Aim Orofacial clefts are the most common congenital anomaly to affect the craniofacial region. Surgical repair is usually performed in infancy; however, there are concerning inequalities in access to and quality of surgical care. Scoring aesthetic results after surgery is crucial when determining the success of a repair. A reliable and accurate scoring system utilising large numbers of unstandardised 2-dimentional (2D) photographs of ethnically diverse patients, which is inexpensive, widely accepted and easily applicable, does not exist. Artificial Intelligence (AI) has been applied in various surgical specialities with beneficial results; however, its advantages have not yet been harnessed in cleft care. We aimed to evaluate the potential use of routinely collected 2D photographs of patients with an orofacial cleft and determine if non-standardised data could be used for machine learning (ML) analysis in cleft research. Method A database comprising over 5 million photographs, collected over 20 years, and developed by the international non-governmental organisation Smile Train, was described, and analysed using RStudio and Microsoft Excel. Results Description and analysis of the dataset demonstrated that it is the largest and most ethnically inclusive and diverse dataset that currently exists. Preliminary AI analysis confirmed that ML could be used to analyse the data. Conclusion The quality of routinely collected data presents challenges for use in research. Addressing such challenges helps ensure that findings are more representative of global burden of disease and will deliver outcomes that are more relevant to a diverse global population. Evidence based minimum standards to optimise future data collection have been identified.

8. Combining Search Query Data with Operation Smile and Smile Train Outreach to Better Understand Global Cleft Surgical Care

8. Combining Search Query Data with Operation Smile and Smile Train Outreach to Better Understand Global Cleft Surgical Care

52. THE EFFECT OF PREOPERATIVE PATIENT CHARACTERISTICS ON POSTOPERATIVE OUTCOMES OF CLEFT PALATE REPAIR: AN ANALYSIS OF GLOBAL SMILE TRAIN DATA

PURPOSE: The aim of this study was to identify patient characteristics that contribute to fistula and postoperative speech outcomes using global Smile Train data. METHODS: Analysis of palatoplasty outcomes was performed for 1,110 Smile Train partner hospitals. Patient factors following palatoplasty, including age, weight, and region, were correlated with fistula occurrence and speech outcomes. RESULTS: 2,560 patients were analyzed. The patients were 46.6% female and 27.5% underweight by WHO standards. Average age at palatoplasty was 24.7 + 0.5 months and at speech assessment was 6.8 ± 0.1 years. Underweight patients had higher incidence of hypernasality and decreased speech intelligibility. Palatoplasty when under 6 months or over 18 months of age had higher rates of affected nasality, intelligibility, and fistula formation. The same findings were seen in Central/South American and African patients, in addition to increased VPD and fistula surgery compared to Asian patients. Central/South American patients were also more likely to require VPD assessment. CONCLUSION: In the largest global cleft outcomes study to date, age and nutrition status were significant predictors of speech outcomes and fistula occurrence following palatoplasty. Outcomes were also significantly impacted by location, demonstrating the need to cultivate longitudinal initiatives to reduce regional disparities. These results underscore the importance of Smile Train’s continual expansion of accessible surgical intervention, nutritional support, and speech-language care.