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Cleft Deformities in Zimbabwe, Africa:  Socioeconomic Factors, Epidemiology, and Surgical Reconstruction

Annette M. Pham, MD; Travis T. Tollefson, MD
Arch Facial Plast Surg. 2007;9(6):385-391. doi:10.1001/archfaci.9.6.qsp70001.
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In the African country of Zimbabwe, a variety of socioeconomic factors have contributed to a lack of specialty care and resources for the indigent population. Although cleft lip and palate has a lower incidence in Africa (0.67 per 1000 births) than in Latin America or Asia, access to reconstructive surgery is often difficult to obtain. A surgical team worked with Zimbabweans at the Harare Central Hospital, Harare, to perform cleft surgery for 39 patients. We review the epidemiology of cleft deformities in Africa, our experience with 39 patients with cleft lip and palate, and the techniques used to address 2 patients with midfacial clefts. To our knowledge, this retrospective case review and epidemiologic literature review is the first review of cleft care in Zimbabwe. Poverty in Zimbabwe, caused in part by the highest inflation rate in the world, has contributed to the emigration of a large number of specialists to other countries. In addition, the health care system is overwhelmed by a high prevalence rate of human immunodeficiency virus (25%), leading to a drastically reduced parental life expectancy (mean life expectancy, 36 years). Primary and secondary cleft lip and palate repairs were completed without complications. Children requiring care beyond the scope of this mission were referred to the Republic of South Africa. The cooperation among the Zimbabwean administration, physicians, and nurses was integral to the organization and successful execution of this reconstructive surgical mission. Ultimately, until the socioeconomic conditions improve in Zimbabwe, training and continuing education of local physicians are imperative to advance the care of children with cleft lip and palate.

Published online October 22, 2007 (doi:10:1001/archfaci.9.6.qsp70001).

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Figure 1.

An example of the screening card used to record patient data. After the patient is evaluated, the diagnosis and surgical plan are recorded. Screening cards are then used to maintain medical records of all the patients evaluated.

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Figure 2.

There were 20 primary cleft lips repaired. A, Preoperative and B, postoperative photographs of a patient with a unilateral incomplete cleft lip. C, Preoperative and D, postoperative photographs of a patient with a unilateral complete cleft lip.

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Figure 3.

A young girl presented with a rare Tessier No. 2 cleft anomaly.5, 12 She also had a congenital nasal mass with an associated pit (black arrow), which would require further workup prior to excision.

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Figure 4.

A 3-year-old with a previous attempt at repair of her median cleft lip. A, Along with a median cleft lip, the patient had a bifid nose and a diastema at the 2 central incisors. Note also the hypertelorism. B, A plain radiograph in the anterior-posterior view demonstrates a median cleft through the skeletal framework (yellow lines). C, The midline cleft lip was repaired using a modified V-Y columellar advancement technique. An immediate postoperative result demonstrates the incisions for the cleft lip revision with extension onto the midline columella.

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Figure 5.

An 18-year-old woman with a median cleft lip and nasal bifidity (A) that is accentuated when smiling (B).

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Figure 6.

An intraoperative photograph depicting exposure of the duplicated septum (black arrow) and divergent lower lateral cartilages using an external rhinoplasty approach.

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Figure 7.

A vascularized fibrofatty tissue flap is rotated into the supratip region to augment the deficient area in the bifid tip secondary to the divergent lower lateral cartilages. Interdomal sutures (5-0 Prolene; Ethicon Inc, Somerville, New Jersey) were used to address the nasal bifidity.

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Figure 8.

Patient 31. Both patients with midfacial clefts (patients 14 and 31) demonstrated a mucosalized tract (black arrow) between the bony maxillary cleft.

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