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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 16-19

Facial deformity correction: A journey through small towns and rural India


1 Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Dentistry, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication21-Nov-2017

Correspondence Address:
Sailesh Kumar Mukul
Department of Dentistry, All India Institute of Medical Sciences, Phulwari Sharif, Patna - 801 505, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jclpca.jclpca_64_17

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  Abstract 

Introduction: Craniofacial anomalies constitute a large fraction of facial deformity cases. The aim of this study is to develop a road map to extend the services for facial deformity correction in small towns and rural parts of the country. The objectives were to assess the existing services for facial deformity correction as a pilot project and to conduct strength, weakness, opportunities, threats analysis of existing care providers for facial deformity correction in Bihar. Methods: A questionnaire was generated titled “Survey on Distribution, Management, Difficulties Encountered and suggestions to improve services to manage the facial deformity cases in a conventional small surgical setup in Bihar” and was distributed among existing care providers for the facial deformity patient. Results: Less than 30% of care providers provide services at small towns and villages. Majority of care providers are centered at the district level. Discussion: The paucity of care providers for corrections of facial deformities needs to increase from mere 30%.This relates to desired increase in capacity by two folds to clear the backlog in a decade in India. Conclusion: At present, no national level policy to address the facial deformities which require to be formulated through established national and international societies and organizations.

Keywords: Craniofacial anomalies, facial deformity TMJ ankylosis


How to cite this article:
Mukul SK, Singh A, Singh S, Singh P, Kumar A. Facial deformity correction: A journey through small towns and rural India. J Cleft Lip Palate Craniofac Anomal 2017;4, Suppl S1:16-9

How to cite this URL:
Mukul SK, Singh A, Singh S, Singh P, Kumar A. Facial deformity correction: A journey through small towns and rural India. J Cleft Lip Palate Craniofac Anomal [serial online] 2017 [cited 2022 Jan 27];4, Suppl S1:16-9. Available from: https://www.jclpca.org/text.asp?2017/4/3/16/218881


  Introduction Top


Craniofacial anomalies constitute a large fraction of facial deformity cases [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d and [Figure 2]a,[Figure 2]b,[Figure 2]c,[Figure 2]d. The aim of this study is to develop a road map to extend the services for facial deformity correction in small towns and rural parts of the country. The objectives were to assess the existing services for facial deformity correction as a pilot project and to conduct strength, weakness, opportunities, and threats (SWOT) analysis of existing care providers for facial deformity correction in Bihar.
Figure 1: (a-d) Congenital hemifacial hyperplasia

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Figure 2: (a-d) Hemifacial microsomia with facial cleft

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  Methods Top


A questionnaire was generated titled “Survey on Distribution, Management, Difficulties Encountered and suggestions to improve services to manage facial deformity cases in a conventional small surgical setup in Bihar” and was distributed among existing care providers for the facial deformity patient. The different care providers who participated in the survey included plastic surgeons, maxillofacial surgeons, and ENT surgeons. Thirty-six surgeons from the pool of different operating surgeons were randomly allocated the questionnaire, and their specific responses were recorded and analyzed. Descriptive analysis was done on SPSS (version 22.0.0) [IBM, Armonk, NY, United States of America], and SWOT analysis was done for the existing service providers.


  Results Top


  • Less than 30% of care providers provide services at small towns and villages, majority of care providers are centered at the district level [Figure 3]a
    Figure 3: (a) What is the hierarchy level of the area, where most of your surgical facilities are offered to address the facial deformity? (b) You are specifically well-trained to treat facial deformity individually? (c) Who operates often at your center to correct the facial deformity? (d) How many patients of facial deformity report at your center in a month? (e) The facial deformity cases reporting at your center are of what origin? (f) Among the congenital cases with facial deformities which are often reported to your center? (g) What is your response on awareness level of patients reporting to your center with a facial deformity? (h) Do you have access to diagnostic aids such as laboratory, computed tomography, magnetic resonance imaging, ultrasonography, and X-ray to diagnose patients and well-equipped operation theater with adequate surgical instruments to correct the facial deformity? (i) Do you have well-trained nursing, operation theater staff, and auxiliary support (counselor, speech therapist, etc.) to assist in the overall management of patients with a facial deformity? (j) Do you have an emergency management (Neonatal Intensive Care Unit, Pediatric Intensive Care Unit, Intensive Care Unit, and High Dependency Unit) support at your center? (k) What is the most common weakness of your center which hinders management of patients at your center? (l) What is the most important threat that affects your center work? (m) Majority of the patient seeking your services reach through?

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  • More than 80% of the care providers are well-trained or work in collaboration with a well-trained specialist which is strength but the weakness is that there are also 12% of care providers who are partially trained [Figure 3]b
  • The weakness in present services is that less than 25% of the service providers work in a combination of the multispecialty team
  • Fifty-nine percent of the service providers see more than 5 cases every month, and more than 80% of the facial deformity cases are the combination of congenital and acquired facial deformities. Among congenital deformities, more than 80% are cleft lip and palate patients
  • The threats are lack of treatment [Figure 3]g,[Figure 3]h awareness in patients which is more than 65%; consultants do not encounter the patients who are completely aware and cooperative for the treatment. Other threats are lack of well-trained support staff (>20%), [Figure 3]i lack of fund and support by government (30%), [Figure 3]j combination of quackery, lack of awareness, and prevailing superstations is about 70% [Figure 3]k,[Figure 3]l
  • The other strengths are more than 80% of care providers have access to basic and advanced diagnostic aids and advanced facilities for the management of facial deformity cases. They also have back up for emergency management [Figure 3]m



  Discussion Top


  • The paucity of care providers for corrections of facial deformities needs to increase from mere 30%. This relates to desired increase in capacity by two folds to clear the backlog in a decade in India[1]
  • Facial deformity is a complex condition that benefits from comprehensive and effective surgery to achieve successful outcome[2],[3]
  • There is a scope for a well-trained specialist with a provision for the multispecialty team
  • There are more than 7200 cases of unrepaired cleft lip/palate in India, and Bihar is the highest in ladder with estimated prevalence of 65.8%[4]
  • According to the WHO norms for monitoring outcomes “Operators treating sixty new cases per year could audit their outcome within a decade” which well correlates with 59% of service providers in Bihar[3]
  • The threat which is a lack of treatment awareness among patients can be best resolved through a trusted relative or friend who has witnessed the miracles of cleft care in her family, village, or community.[1] The patient recommendation is the main source for visit of the patient to care providers (65%)



  Conclusion Top


  • At present, no national level policy to address the facial deformities which require to be formulated through established National and International Societies and Organisations
  • To address this burden strategies such as short-term mission programs, comprehensive care centers, and support of local health-care system should be formulated
  • The establishment of efficiently run, high volume, indigenous centers of excellence, capable of serving large, and widespread populations through outreach satellites
  • Support for the indigenous specialists may also be provided
  • Moreover, this International congress will provide us an opportunity for appraisal of our concept model. This may further help in the refinement of the concept model.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Singh SK. Smile train: The ascendancy of cleft care in India. Indian J Plast Surg 2009;42 Suppl:S192-8.  Back to cited text no. 1
    
2.
Hodges S, Wilson J, Hodges A. Plastic and reconstructive surgery in Uganda-10 years experience. Paediatr Anaesth 2009;19:12-8.  Back to cited text no. 2
[PUBMED]    
3.
World Health Organization. Global Registry and Database on Craniofacial Anomalies: Report of A WHO Registry Meeting of Craniofacial Anomalies. Geneva, Switzerland: World Health Organization; 2001.  Back to cited text no. 3
    
4.
Stewart BT, Carlson L, Hatcher KW, Sengupta A, Vander Burg R. Estimate of unmet need for cleft lip and/or palate surgery in India. JAMA Facial Plast Surg 2016;18:354-61.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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