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Yamada A, Chwa ES, Boctor MJ. Update on Total Auricular Construction. Plast Reconstr Surg 2024; 153:1011e-1021e. [PMID: 38657012 DOI: 10.1097/prs.0000000000011219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand principles of preoperative planning for microtia repair. 2. Understand key techniques for flap design, skin envelope dissection, framework creation, and donor-site reconstruction. 3. Describe important components of postoperative management. SUMMARY Total auricular construction remains a challenge for reconstructive surgeons. This article describes current surgical strategies and advancements for microtia construction. The authors' focus is to describe the several keys for success that are useful for young surgeons who wish to train themselves to create satisfactory results.
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Affiliation(s)
- Akira Yamada
- From the Division of Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital
- Northwestern University Feinberg School of Medicine
| | - Emily S Chwa
- Northwestern University Feinberg School of Medicine
| | - Michael J Boctor
- Northwestern University Feinberg School of Medicine
- Department of Plastic Surgery, Loma Linda University Health
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Chwa ES, Stoehr JR, Gosain AK. Predictors of Adverse Outcomes Following Cleft Palate Repair: An Analysis of Over 2500 Patients Using International Smile Train Data. Cleft Palate Craniofac J 2024; 61:844-853. [PMID: 36594527 DOI: 10.1177/10556656221148901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE 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. DESIGN Multi-institution, retrospective review of Smile Train Express database. SETTING 1110 Smile Train partner hospitals. PATIENTS/PARTICIPANTS 2560 patients. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jenna R Stoehr
- Division of Plastic and Reconstructive Surgery, University of South Florida, Tampa, IL, USA
| | - Arun K Gosain
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Gutowski KS, Chwa ES, Weissman JP, Garg SP, Simmons CJ, Brandt KE, Gosain AK. Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics. Plast Reconstr Surg Glob Open 2023; 11:e5486. [PMID: 38145152 PMCID: PMC10745238 DOI: 10.1097/gox.0000000000005486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023]
Abstract
Background Evaluation of practice patterns by American Board of Plastic Surgery (ABPS) diplomates allows for a greater understanding as to how the field is progressing. Understanding evolving procedural trends can give insight into plastic surgeons' subspecialty focus and influence resident training to prepare them for future practice. Methods American Society of Plastic Surgeons member only projections for aesthetic and reconstructive procedures were reviewed from 1999 to 2018 in 5-year increments to identify shifts in frequency between the beginning (1999-2003) and end (2014-2018) of the timeframe. Tracer utilization for all four ABPS modules were also examined between 2014 and 2018. Descriptive statistics were performed to identify significant changes (P < 0.05) in subspecialty focus and procedure trends. Results Annual procedure incidence between 2014 and 2018 was compared with that between 1999 and 2003. The annual number of procedures more than doubled from 3,244,084 to 6,628,082. Among reconstructive procedures, there was a statistically significant increase in the number of breast reconstruction, breast implant removal, and maxillofacial surgery procedures, and a statistically significant decrease in the number of procedures focused on reconstruction of birth defects, burn injuries, and hand anomalies. In aesthetic surgery, significant increases were seen in the number of augmentation mammoplasty, abdominoplasty, and mastopexy procedures, with significant decreases in the number of blepharoplasty and rhinoplasty procedures. Conclusions Understanding the changing practice patterns of ABPS diplomates is essential to define the direction that our specialty is taking over time, and to guide program directors in plastic surgery on areas of focus for appropriate training of plastic surgeons.
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Affiliation(s)
- Kristof S. Gutowski
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
- Kansas City University College of Osteopathic Medicine, Kansas City, Mo
| | - Emily S. Chwa
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joshua P. Weissman
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stuti P. Garg
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | | | - Arun K. Gosain
- From Division of Plastic Surgery, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Chwa ES, Applebaum SA, Khazanchi R, Wester JR, Gosain AK. Racial Disparities Following Reconstructive Flap Procedures. J Craniofac Surg 2023; 34:2004-2007. [PMID: 37582256 DOI: 10.1097/scs.0000000000009595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Prior reports have highlighted disparities in healthcare access, environmental conditions, and food insecurity between Black and White populations in the United States. However, limited studies have explored racial disparities in postoperative complications, particularly reconstructive flap surgeries. METHODS Cases of flap reconstruction based on named vascular pedicles were identified in the American College of Surgeons National Surgical Quality Improvement Program database and grouped into 3 time periods: 2005 to 2009, 2010 to 2014, and 2015 to 2019. Logistic regression was used to compare rates of postoperative complications between White and Black patients within each time period while controlling for comorbidities. Data for flap failure was only available from 2005 to 2010. RESULTS A total of 56,116 patients were included in the study, and 6293 (11.2%) were Black. Black patients were significantly younger than White patients and had increased rates of hypertension, smoking, and diabetes across all years ( P <0.01). Black patients had significantly higher rates of sepsis compared to White patients in all time periods. From 2005 to 2009, Black patients had a significantly higher incidence of flap failure (aOR=2.58, P <0.01), return to the operating room (aOR=1.53, P =0.01), and having any complication (aOR=1.48, P <0.01). From 2010 to 2019, White patients had a higher incidence of superficial surgical site infection. CONCLUSIONS Surgical complication rates following flap reconstruction based on a named vascular pedicle were higher for Black patients. Limited data on this topic currently exists, indicating that additional research on the drivers of racial disparities is warranted to improve plastic surgery outcomes in Black patients.
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Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine and the Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
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Chwa ES, Shah ND, Gosain AK. Impact of the Virtual Format on Plastic Surgery Residency and Fellowship Interviews: A National Cross-Sectional Study. Plast Reconstr Surg 2023; 152:763e-764e. [PMID: 37768228 DOI: 10.1097/prs.0000000000010670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Emily S Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nikhil D Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
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Garg SP, Weissman JP, Chwa ES, Galiano RD. Content Validity of a Novel Scar Assessment Tool Evaluating the Career and Sexual Well-being Impact of Scars. Plast Reconstr Surg Glob Open 2023; 11:e5118. [PMID: 37448762 PMCID: PMC10337705 DOI: 10.1097/gox.0000000000005118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
Currently, patient reported outcome scales used to assess scar impact focus solely on psychosocial well-being, symptoms, and appearance. There remains a need to develop a broadened measure of scar impact on patients, focusing on sexual and career aspects. This study investigates the content validity of the novel Career and Sexual Well-being (CS) Scar Impact Scale. Method The CS scale contains five questions and was developed from previous patient thematic analysis interviews describing scar impact, and covers self-conscious behavior, new partners, hiding of the scar, being hindered in the workplace, and concerns regarding unprofessional appearance. Cognitive interviews and established guidelines were used to ensure that the scale was comprehensive, reproducible, and easily understandable. Results In total, 86 patients completed cognitive interviews. Patients had a clear understanding of the questions and elicited their intent in the interviews. An estimated 86% of patients rated the CS scale coverage of scar impact on career and sexual health at a three or above out of four; 95% said the specific instructions were clear, and 92% stated it took them less than 4 minutes to complete the scale. After the first round of interviews, a question about "perception/self-consciousness in a professional environment" was added based on patient suggestions. Conclusions The CS scar scale demonstrated face validity, acceptability, and field-readiness through cognitive interviewing of patients at our institution. Sexual well-being and career performance are important yet often neglected themes with which scars should be assessed. Usage of these tools would serve to improve current scar scales.
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Affiliation(s)
- Stuti P. Garg
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Joshua P. Weissman
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Emily S. Chwa
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Robert D. Galiano
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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Reddy NK, Shah ND, Weissman JP, Chwa ES, Gosain AK. Evaluation of Global Cleft Care Initiatives Among the Top Searched Low- and Middle-Income Countries. Cleft Palate Craniofac J 2023:10556656231160399. [PMID: 36866656 DOI: 10.1177/10556656231160399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE International outreach for cleft lip and/or palate care has traditionally been characterized by foreign groups and individuals holding surgical outreach trips in low- and middle-income countries. However, this "magic bullet" approach has often been criticized for prioritizing short-term results that may disrupt local workflow. The presence and impact of local organizations that support cleft care and take on capacity building initiatives has not been well explored. DESIGN Eight countries previously studied as having the highest Google search demand for CL/P were chosen for the scope of the study. Local NGOs in regions were identified through a web search, and information was collected regarding the location, objectives, partnerships, and work conducted thus far. RESULTS Countries with a strong combination of local and international organizations included Ghana, Philippines, Nepal, Kenya, Pakistan, India, and Nigeria. The country with minimal to no local NGO presence included Zimbabwe. Local NGOs often supported education and research, training of providers and staff, spreading community awareness, offering interdisciplinary care, and opening cleft clinics and hospitals. Unique initiatives included starting the first school for children with CL/P, enrolling patients in the national healthcare to cover CL/P care, and monitoring the referral system to improve efficiencies in the healthcare system. CONCLUSIONS Moving towards a mindset of capacity building not only involves bilateral partnerships between international host sites and visiting organizations, but also collaboration with local NGOs that have a deep understanding of local communities. Successful partnerships may help address the complex challenges regarding CL/P care faced by LMICs.
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Affiliation(s)
- Narainsai K Reddy
- Texas A&M School of Medicine, Engineering Medicine (EnMed), Houston, Texas, USA
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Nikhil D Shah
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Joshua P Weissman
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Lurie Children's Hospital, Chicago, IL, USA
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Gutowski KS, Applebaum SA, Thomae BL, Knight KC, Chwa ES, Gosain AK. The Quality and Readability of Online Patient Information on Positional Head Shape Conditions. Cleft Palate Craniofac J 2023:10556656231159972. [PMID: 36850070 DOI: 10.1177/10556656231159972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Families increasingly use online resources to acquire medical information about their child's condition with little understanding of the legitimacy of the source of information or of the information itself. We evaluate the quality and readability of online information related to positional head shape conditions and identify unmet needs for healthcare providers to improve online patient education. DESIGN The search terms "flat head baby," "brachycephaly," and "plagiocephaly" were queried on the Google search engine and the first 20 websites for each were reviewed. Included websites were evaluated for quality using the DISCERN Instrument and readability using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Websites were categorized by upload source and results were compared using one-way ANOVA. RESULTS 38 websites met inclusion criteria. There was no significant correlation between DISCERN score and Google search rank between the three search terms. Professional organizations provided websites with the highest mean DISCERN score (56.3) and commercial websites with the lowest score (36.6, P = .003), indicating "good" and "poor" quality content, respectively. Readability assessments showed an overall average FKGL of 9.9 and FRES of 54.4, suggesting "fairly difficult". Hospitals provided the most website results and tended to publish lower quality information, yet are the most readable. CONCLUSIONS High quality websites written at an appropriate reading level for the general public are lacking. A review of online resources for positional head shape conditions can be used to derive recommendations to improve the content of online patient education for pediatric healthcare.
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Affiliation(s)
- Kristof S Gutowski
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Sarah A Applebaum
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Benjamin L Thomae
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Karlee C Knight
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily S Chwa
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, 2429Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
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Santiago GS, Santiago CN, Chwa ES, Purnell CA. Positional Plagiocephaly and Craniosynostosis. Pediatr Ann 2023; 52:e10-e17. [PMID: 36625797 DOI: 10.3928/19382359-20221114-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Along with the decrease in sudden infant death syndrome due to the successful "Back to Sleep" Campaign, there was a reciprocal increase in cases of positional plagiocephaly (PP). The prevalence of PP significantly rose from approximately 5% to upward of 46% at age 7 months. Consequently, clinicians have seen a surge in the number of patients presenting with head shape abnormalities. Not only does this increase in patient volume pose a logistical problem to clinics, but it also poses a potential risk to patients with craniosynostosis, whose head shape anomalies are similar to a "needle in a haystack" of patients with more common PP. This review explores the causes, risk factors, and treatment options of PP and craniosynostosis, along with the differential of head shape anomalies based on phenotypic presentation. In doing so, we hope to provide pediatric care clinicians with the tools necessary to effectively evaluate and manage patients with head shape abnormalities. [Pediatr Ann. 2023;52(1):e10-e17.].
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Chwa ES, Weissman JP, Applebaum SA, Gosain AK. The financial implications of telemedicine practice patterns across pediatric surgical specialties. J Pediatr Surg 2022; 57:860-864. [PMID: 35649744 PMCID: PMC9077903 DOI: 10.1016/j.jpedsurg.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Telemedicine has played an increasingly important role in surgical care during the coronavirus disease 2019 (COVID-19) pandemic, yet little is known about its usage and correlation to cost both within and across surgical specialties during the pandemic. STUDY DESIGN We collected data on telehealth encounters from April 2020 to June 2021 for all surgical specialties at a pediatric academic institution. The percent of total encounters that were telemedicine vs. in-person were analyzed over time. Data on charge and reimbursement were averaged for each encounter type, and the percent difference in average charge and reimbursement was calculated and compared between surgical specialties. RESULTS Of the 147,007 surgical clinical visits identified, 6,566 encounters (4.5%) were telemedicine. Usage peaked in April and plateaued in June of 2020. The specialties with the highest total percentages of telemedicine visits were neurosurgery (23.2%) and cardiovascular-thoracic (11.9%). Orthopedics reported the lowest usage at 2%. Charges for in-person encounters were higher for nearly all specialties while reimbursements remained equal. CONCLUSION Our institutional trends reveal that conversion to telemedicine varied across surgical specialty during the COVID-19 pandemic. Charges for in-person encounters were higher than telehealth ones for nearly all specialties, but the reimbursements were fairly the same. Understanding trends in telemedicine volume instigated by and following the pandemic may better prepare pediatric institutions to navigate the accelerated adoption and influence policy changes. This is particularly relevant given the fluctuating impact of the pandemic on healthcare institutions as new strains of COVID-19 emerge. EVIDENCE LEVEL Level V.
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Affiliation(s)
- Emily S. Chwa
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joshua P. Weissman
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah A. Applebaum
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 93, Chicago, IL 60611, United States
| | - Arun K. Gosain
- Division of Pediatric Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 93, Chicago, IL 60611, United States,Corresponding author
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Wester JR, Weissman JP, Reddy NK, Chwa ES, Gosain AK. The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review. Cleft Palate Craniofac J 2021; 59:1131-1138. [PMID: 34397305 DOI: 10.1177/10556656211038183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify practices and limitations of cleft care in sub-Saharan Africa (SSA). DESIGN A retrospective narrative nonsystematic literature review was performed. SETTING Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included. PARTICIPANTS Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. MAIN OUTCOME MEASURES Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships. RESULTS Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes. CONCLUSION This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.
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Affiliation(s)
- James R Wester
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua P Weissman
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Emily S Chwa
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,2429Lurie Children's Hospital, Chicago, IL, USA
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