CLEFT LIP AND PALATE: THE BURDEN OF CARE IN INDIA

Purpose: Cleft lip and palate is one of the most common craniofacial anomalies with an incidence rate of 1:700 life birth in India. The treatment for the children commences immediately after  birth and continues till late adolescence. The various treatment modalities include primary lip and palate repair, speech therapy, alveolar bone grafting, correction of mid-face hypolasia and rhinoplasty. Each of the  modality needs assessment in terms of clinical efficacy influencing the overall burden of care.

Method(s): 30 patients with incomplete unilateral cleft lip, complete unilateral cleft lip, complete unilateral cleft lip and palate, complete bilateral cleft lip and palate were operated at 4-6 months of the age and assessed for long term esthetic and functional results with the help of standardized photographs, models and radiographs at 3 yrs. 5yrs and 6yrs respectively. 30 patients with unilateral cleft palate and 30 patients with bilateral cleft palate operated between 12-14 months underwent speech assessment between 4-6 years. 30 patients with cleft alveolus who underwent alveolar bone grafting were assessed for bone uptake, survival of the graft and nasal changes with the help of chelsea scale and photographs respectively after 1yr follow up. 60 patients with maxillary hypoplasia as a result of cleft were divided into two groups. 30 pts underwent traditional orthognathic surgery and rest anterior maxillary distraction respectively. Both the groups were analysed with the help of lateral ceph for relapse and positive profile changes. 60 patients who underwent rhinoplasty for cleft nose were analysed objectively for esthetic outcome

Result(s): The results for the various modalities were compiled and subjected to statistical analysis and were found to be significant, therefore demonstrating the efficacy of each of the modality employed. 

Conclusion(s): The modalities employed in the comprehensive management of cleft lip and palate in our study were found to be clinically and statistically justified, therby influencing the burden of care significantly and supporting the protocol followed at our centre.