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| FOREWORD BY THE PRESIDENT |
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| Year : 2014 | Volume
: 1
| Issue : 1 | Page : 3 |
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Cleft care at cross road
Arun Kumar Singh
Department of Plastic Surgery, K G Medical University, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 5-Feb-2014 |
Correspondence Address:
Arun Kumar Singh
Department of Plastic Surgery, K G Medical University, Lucknow - 226 003, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2348-2125.126535
How to cite this article:
Singh AK. Cleft care at cross road. J Cleft Lip Palate Craniofac Anomal 2014;1:3 |
Cleft care in India today is at cross roads. With an incidence of around 1 cleft per 1000-2000 live births, in a population of 1,000,000,000 we would have approximately 1,000,000 clefts in the society. The burden is immense. Many voluntary organizations have come forward to help these children. A lot of back log has been tackled especially in the urban areas. Indian cleft care providers are, at a modest estimate, operating around 32,000-34,000 clefts every year. Still with a cleft burden of approximately 1 million and 21,000 new clefts being born every year, it is a tough fight.
In the west, the treatment is now nearly standardized. Few designated centers are taking care of oro-facial cleft, holistically from birth to adulthood. Multidisciplinary teams are in place; be it prosthodontic support, orthodontic support, speech therapy and even social support.
In our country, though primary surgeries of cleft are now being done at earlier ages and untreated adult cleft cases being seldom seen, holistic cleft care is still a distant dream.
The number of centers, who have provisions of multi-disciplinary cleft care from birth to adulthood, can be counted on fingertips. Long-term record keeping and follow-up is abysmally dismal. Facilities of Naso alveolar molding, or pre-surgical orthopedics are virtually non-existent. The arches are often non-aligned before the primary surgery and the nasal platform unequal.
Even after the lip is repaired the nasal deformity persists and the nose continues to grow in an unnatural position. Stigmata of cleft are noticeable even from a distance. Palate repair, in the absence of prosthdontic support further hampers the growth of the palate. The arches remain collapsed. Dental caries are rampant, leading to loss of teeth and often the take of alveolar bone graft is poor. By adulthood, the deformity is firmly established and these young adults require skeletal correction, either by orthognathic surgery or by distraction. Facilities for the same are also lacking at many centers.
The situation for craniofacial anomalies is still more alarming. Very few centers provide treatment for craniofacial anomalies be it craniostenosis, hypertelorism, various other syndromes associated with these. Most of these deformities require complex and prolonged surgeries with the potential of mortality, necessitating good pediatric intensive care units. The need of the day is that such specialized regional centers should be developed in various parts of the country, where such cases could be referred and treated.
I am pleased to inform that the Indian Society of Cleft Lip Palate and Craniofacial Anomalies is re-launching its official organ- the Journal of Cleft Lip, Palate and Craniofacial Anomalies, with the aim of showing the collective academic and practical experience of cleft care providers in India. The Journal would also strive to discuss the nitty gritties of the scientific basis of cleft care and try "evolve consensus in cleft care" whereby optimum care could be provided even under constrained resources.
With a dynamic editorship and the support of a vibrant publisher, the journal, I am sure will be a leading source of scientific data for the 3 rd world and other countries. We have the experience of managing clefts in vast numbers. I am sure that this Journal in its new "avtar" will fill the void between the experience and scientific reasoning.
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