The impact of economic prosperity on treatment protocols for cleft patients in Europe and North America

Abstract

The rehabilitation of patients with cleft lip and palate anomalies requires years of specialized care and coordinated treatment steps. Since there are no generally accepted guidelines, this thesis aimed to gain a numerical overview of different cleft care modalities in Europe and North America and analyze their distribution in relation to the countries’ economic prosperity. <br /> Envisioned as a follow-up to the Eurocleft Project 1996-2000, a web-based questionnaire inquiring information about surgical, orthopedic and other interventions and their popularity was sent to cleft centers across Europe and North America after identifying them by a standardized procedure. The nations of the participants were then ranked according to their GDP per capita and divided into two groups above and below European average. The runtime of the questionnaire was 11 months, during which out of 372 identified cleft teams (184 European and 188 North American), 88 mainly European participants from 25 different nations responded. <br /> The analytical statistics of the results revealed, that despite various disparities in care for cleft patients throughout Europe and the world, the economic prosperity of a country plays a less important role regarding certain treatment steps than expected. The number of disciplines involved in cleft treatment is not larger in prosperous countries than in less prosperous countries. Cleft patients in prosperous countries are not earlier discovered through prenatal diagnosis than in less prosperous countries. It could also be demonstrated, that the quantity of primary operations (number of surgical interventions until cleft closure) and the frequency of so-called secondary operations (tympanoplasty, velopharyngoplasty and (septo-)rhinoplasty) did not significantly differ between two groups. The only surgical procedure that was more frequently carried out in wealthier countries was paracentesis. No statistically significant association between a country’s prosperity and the frequency of presurgical orthopedic treatment could be made. The same applies for additional examinations (like hearing tests or other functional testing). <br /> However, the evaluation of the collected data showed some interesting changes with regard to the results of the Eurocleft Project twenty years ago. The use of presurgical orthopedics has considerably increased and especially nasoalveolar molding appliances seem to be on the rise, despite intraoral-only appliances still being used by the majority of specialists. Surgical interventions and their timing remained mostly unchanged compared to the Eurocleft Project, except a slight increase in number of operations until the definite closure of a unilateral cleft. <br /> Future research will be reserved to examine further similarities and differences of the immense amount of data collected by the present work comparatively with the Eurocleft Project and other studies, which - together with an enhanced multicenter collaboration between specialists in the broad field of cleft care - can contribute to establish practical treatment guidelines and to define optimal protocols for cleft patients.