Introduction to “Advances in Cleft Care”

As the most common congenital craniofacial difference, clefts of the lip and palate constitute an incredible burden worldwide. With an incidence estimated at 1 of every 700 births globally, this translates to almost 195,000 babies born with a cleft every year.1,2 As of 2017, the prevalence was estimated to be almost 11 million persons with repaired or unrepaired clefts. A significant percentage of these are in low- and middle-income countries, where access to any surgery is challenging. Even in cases where a child with a cleft can undergo a successful surgical procedure, access to the full spectrum of cleft care, including orthodontic and speech interventions, is uncommon in most limited-resource settings. In 1999, a nonprofit organization called Smile Train was founded to address this issue. It was felt that the only sustainable solution that was scalable to the magnitude of the cleft problem worldwide was to identify and engage qualified local health care professionals and institutions to provide these services. Funding was only provided for cleft care after a safe and successful treatment was performed and the documentation (including photographs) was submitted for evaluation using a proprietary online database. In 2016, an independent research group performed an economic evaluation of the impact of Smile Train in terms of disability-adjusted life years averted and financial contributions to local communities from the primary cleft operations. In an update of these data examining primary operations funded from 2001 to 2023, the estimate was 12.8 million disability-adjusted life years averted with a financial contribution of almost 70 billion dollars.3 The supervision of the safety and quality of cleft care funded by Smile Train is provided by a global medical advisory board composed of cleft care providers from across the world in all requisite areas, such as surgery, anesthesia, nursing, speech, and orthodontia. Members of this board were recently asked to provide updates on the current state of the art in cleft treatment, with an emphasis on care that could be provided even in low-resource settings. This supplement is a collection of those thoughts and experiences, representing more than 2 million operations and countless other cleft treatments funded by Smile Train and supervised by these cleft professionals. The techniques presented in this supplement to Plastic and Reconstructive Surgery do not necessarily represent best practices or endorsed techniques of the guest editors, editor-in-chief, editorial board, the American Society of Plastic Surgeons (ASPS), or Wolters Kluwer Health. Publication of supplements does not constitute product or sponsor endorsement by this Journal or the ASPS. This supplement was made possible by a sponsorship from Smile Train. Some current and past advisors, investigators, and consultants for Smile Train did serve among the guest editors and authors on the chapters herein, as allowed by the ASPS Supplement Publication Policy; all authors are listed on the articles as authors or acknowledged contributors, as Plastic and Reconstructive Surgery does not support ghostwriting. As with all Plastic and Reconstructive Surgery articles, financial disclosure statements are provided for each article, and with all supplements, they are intentionally and redundantly included as an appendix, for your convenience. None of the materials contained in this supplement are considered practice guidelines or best medicine protocols but are merely the authors' collective experience and expertise in the prescribed area. These articles have been rigorously peer-reviewed and revised before acceptance. We thank all the authors who took time out of their busy careers to prepare these outstanding papers, and we must also thank the group of plastic and reconstructive surgeons and affiliated specialists who served as expert, unbiased, and efficient peer reviewers. These women and men worked on important topics and remained proficient, meticulous, and dependable. This supplement would not have been possible without them. DISCLOSURE Dr. Hollier is the chair of Smile Train's Global Medical Advisory Board; this is a volunteer position. Drs. Hopper and Flores are members of Smile Train's Global Medical Advisory Board; these are volunteer positions.