The Journal of craniofacial surgery · 2025
"Presurgical Infant Orthopedics in Low-Income and Middle-Income Countries: Demographics, Access, and Treatment Outcomes From the Smile Train Express Database".
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Tanikawa Daniela Y S, Batra Puneet, Pandan Janet, Thao Dinh T N, Escobar-Palacios Daniela, Figueroa Álvaro A
Аннотация
BACKGROUND: Presurgical infant orthopedics (PSIO) is widely used to reduce cleft severity, improve nasal symmetry, and facilitate primary lip repair. While extensively implemented in high-income countries (HICs), its feasibility, accessibility, and effectiveness in low-income countries and middle-income countries (LMICs) remain uncertain. This study assessed PSIO implementation, accessibility, and outcomes across 5 Smile Train partner centers in LMICs.
METHODS: A retrospective multicenter analysis was conducted using the Smile Train Express (STX) database from 5 LMIC centers in Brazil, Mexico, India, Vietnam, and the Philippines. Data on PSIO initiation, completion, follow-up frequency, and surgical timing were collected. Anthropometric outcomes, including nostril width ratio (NWR) and columellar angle (CA), were analyzed to assess treatment effectiveness across different PSIO techniques. The age at surgery was compared between the PSIO and non-PSIO groups.
RESULTS: PSIO significantly reduced cleft severity and improved nasal symmetry in all centers, with no statistically significant differences in NWR and CA between techniques. Treatment initiation ranged from 2.9 to 9.5 weeks, and completion from 2.8 to 8.2 months. PSIO coverage varied (16%-50%), reflecting differences in referral systems. Follow-up frequency ranged from 1.3 to 3.2 visits per month. The interval between PSIO completion and surgery varied across centers. Patients who received PSIO underwent earlier surgery than non-PSIO patients in most centers.
CONCLUSIONS: PSIO is effective in LMICs, with alternative techniques achieving comparable outcomes to NAM. Strengthening referral pathways, standardizing protocols, and expanding partnerships with public health systems are essential for optimizing cleft care in resource-limited settings.
METHODS: A retrospective multicenter analysis was conducted using the Smile Train Express (STX) database from 5 LMIC centers in Brazil, Mexico, India, Vietnam, and the Philippines. Data on PSIO initiation, completion, follow-up frequency, and surgical timing were collected. Anthropometric outcomes, including nostril width ratio (NWR) and columellar angle (CA), were analyzed to assess treatment effectiveness across different PSIO techniques. The age at surgery was compared between the PSIO and non-PSIO groups.
RESULTS: PSIO significantly reduced cleft severity and improved nasal symmetry in all centers, with no statistically significant differences in NWR and CA between techniques. Treatment initiation ranged from 2.9 to 9.5 weeks, and completion from 2.8 to 8.2 months. PSIO coverage varied (16%-50%), reflecting differences in referral systems. Follow-up frequency ranged from 1.3 to 3.2 visits per month. The interval between PSIO completion and surgery varied across centers. Patients who received PSIO underwent earlier surgery than non-PSIO patients in most centers.
CONCLUSIONS: PSIO is effective in LMICs, with alternative techniques achieving comparable outcomes to NAM. Strengthening referral pathways, standardizing protocols, and expanding partnerships with public health systems are essential for optimizing cleft care in resource-limited settings.