The future of cleft care

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Hospital and School

Surgery

Dr Gosla and Dr Raj outside the Institute of Facial Plastic Surgery
Dr Raj and Dr Gosla (right) outside the Institute of Facial Plastic Surgery

Good results with primary surgery cannot be obtained by merely repositioning the superficial tissues. The aim must be to restore the anatomy and therefore the function of the underlying muscles. In this way, one can expect more normal development of the facial skeleton. These principles are not only important in primary surgery but are also invaluable in the correction of secondary abnormalities due to clefts,  both during development and when growth has ceased. Careful muscle reconstruction, even at a later date, is essential for normal appearance and function of the lip.

Therefore, it is essential for trainee surgeons to learn techniques that will achieve the best outcome.

Future Faces Junior Surgical Fellowships at the GSR Hospital in Hyderabad follow an educationally approved and monitored programme for a period of 12 -18  months.

The  cost of an 18 month programme is £5000. Can you help fund part or all?

Future Faces also funds shorter periods of training at GSR Hospital for more experienced surgeons, tailored to their specific requirements

The cost of a shorter programme for more experienced trainees is about £100 pw, usually for one, two or three months

Speech Therapy

Cleft patient and motherThe Speech Therapist is vital to ensure that the child is able to develop good speech.  This necessitates regular assessments and where needed appropriate intervention with speech programmes and training for others who may be involved.

Assessment of speech is ideally performed by a speech therapist who specialises in cleft  patients,  usually, from the age of about two up to five years but earlier if possible. If there are problems regarding the child’s speech, the therapist will provide appropriate guidance. Parents play a very important role in working with the child to encourage the development of normal speech. The speech therapist (sometimes known as the speech pathologist) will provide guidance  throughout this process. If any abnormality in speech is suspected, certain diagnostic studies may be necessary such as nasopharyngoscopy. This is a technique used by the physician to visualize or look at the back of the throat and movement of the soft palate. Recordings of these movements are made on a videotape synchronized with the speech sounds.

These assessments need to be carried out by therapists who have had the appropriate training and Future Faces provides funded fellowships for this at the GSR Hospital in Hyderabad. We are currently funding a senior therapist to develop a programme for surgical follow up and ongoing therapy in the community – cost £5000. Shorter programmes are also funded

Future Faces also provides funds for training for Community Health Visitors, Parent Community Health Visitors and Community Speech Therapists so as to deliver the best standards of care in the wider community

Cleft School Project

HCS-CLEFT KINDER SCHWEIZ SCHOOL (HCS-CKHS SCHOOL)

A great school photo!

The Cleft School project, which was opened in 2009 in order to provide underprivileged children with clefts, is currently funded by a Swiss charitable foundation, Cleft Kinder Schweiz. At present, there are 80 children with space for 30 more. The children  attend a privately funded mainstream English medium school so that pupils can build friendships outside the project in a conventional setting. Students participate in a variety of physical and social activities and are also provided with personalised schedules for specialised treatments and therapies. These children are assured a high standard of education and are given opportunities to develop careers related to craniofacial anomalies so that they can bring relevant experience and support to future patients. Other vocational opportunities are also provided to students at the School.

There are opportunities for professionals to help

Healthcare professionals linked to the GSR hospital are able to help develop long-term healthcare plans for residents at the Cleft School including post-operative follow-up, speech therapy, assessments and further surgical, treatments and therapies. Teachers are always welcome to share their expertise with students at the School.

and also for volunteers

Volunteering positions can include varied pastoral care such as cooking, building maintenance and other kinds of support under the direction and supervision of the Director and professional staff. Help with developing IT skills, troubleshooting IT development, promoting art and dramatic productions and yoga tutors are a few of the sorts of volunteers who might help to enrich the lives of the School’s residents.

Feeding and Nutrition

Cleft healthcareThe Community Health Visitor and Speech Therapist play an important role in ensuring good feeding, both pre and post surgery.  This is both nutritional and practical.  The child requires to be as fit as possible for surgery and good post surgery nutrition is important for wound healing.

Future Faces funds and provides appropriate training to community healthworkers

Hearing

It is common for children with cleft palate to have associated problems with the middle ear and therefore with hearing. Most of these problems are caused by a malfunctioning of the Eustachian tubes which are small passages that lead from the middle ear to the throat. Their function is to allow pressure to equalize on the inside of the eardrum or tympanic membrane. They also serve to drain any fluid that may accumulate in the middle ear. When the Eustachian tubes are not functioning properly, fluid can build up in the middle ear, causing discomfort and temporary or even permanent hearing loss. This is treated by inserting small drainage tubes called grommets into the ear drum. With surgical treatment and continued regular assessment and care, hearing loss can be prevented.

Future Faces provides funds and training programmes for appropriate professionals to ensure patients achieve optimum hearing

Growth of the face & the teeth

Growth of the face & the teethBecause cleft palate affects the shape and growth of the upper jaw, the teeth become a special consideration. Development and alignment of the teeth and their relationship to the jaw needs to be addressed during infancy and throughout the child’s growing years. As the child grows, the bony arch that supports the teeth, the alveolus, may become too narrow or incorrectly shaped. This condition is called collapse of the alveolar arch and requires orthodontic treatment. Ultimately, at the site of cleft in the alveolus, a bone graft may be required to restore continuity of the facial bones to allow the teeth to develop and to promote better development of the face. At a later date, if mid-facial development has been poor, surgery (osteotomies) may be required to advance these bones and normalise the jaw relationships. Many adults with clefts have not had the benefit of being treated.

These people can benefit from treatment to correct the persistent problems they face. They are never too old to benefit from recent advancements in the multidisciplinary management of clefts.

Future Faces provides training for orthodontists and dentists through fellowships and regular training programmes organised at the GSR Hospital in Hyderabad

 

Community projects

Back to schoolEducational programmes

Opportunities to volunteer in the community are wide-ranging but the primary focus is to promote the understanding of cleft conditions amongst all communities, facilitate inclusion and deliver specific healthcare skills such as post operative follow-up of cleft surgeries, speech therapies under the direction of GSR hospital, and volunteer support to help deliver these objectives.

Prevention, nutrition, wound care

A range of paid and voluntary staff are needed to ensure that patients receive a high standard of care as well as the most current information about the treatment of cleft conditions and how to advise patients and their families about the range of foods which provide appropriate nutrients to assist with pregnancy, post-surgical diets and general health.

Research

researchFuture Faces is committed to building upon the substantial research already collected over many years. Gathering information about genealogy, diet, sanitation and social structures helps healthcare professionals to better understand the backdrop of the incidence of cleft conditions and can make a real difference to the general health of rural communities. This sort of data helps healthcare professionals to understand what the challenges are so that they can improve healthcare at local levels. Research data is shared with national healthcare professionals so that they can better understand how to improve the delivery of service across the country but also, this data is used more widely to research a wide spectrum of healthcare issues.