A "first-of-its-kind" workshop was held in AIIMS to train more than 100 orthodontists from across the country and Nepal to offer comprehensive treatment for facial deformities in children like cleft lip. Specialists from medical and dental fraternity, including plastic surgeons, cleft orthodontists, pediatricians, clinical geneticist and clinical psychologists, contributed as course faculty to explainparticipants about complete protocols of the cleft treatment with greater importance on correcting deformities of face due to poor dental alignment and incoherent speech.

Cleft lip or cleft palate is a condition when the two sides of the lip in a developing unborn baby, do not completely fuse. This adversely affects nutrition, can lead to chest infections, ear problems, poor speech and inability in proper chewing.

The abnormal arrangement of teeth, poor jaw relations and facial aesthetics can make a child socially and functionally handicap. Prof Kharbanda, an eminent cleft craniofacial orthodontist and chief of the Centre for Dental Education and Research at AIIMS, said that cleft lip and palate anomaly constitute approximately one-third of all congenital malformations of the craniofacial region with an average worldwide prevalence of 1 in 700.

The incidence of these anomalies in the Asian population is reported to be around 1.7 per 1,000 live births or higher. The doctor said that in India, more than 35,000 cleft children are born every year, and they add to huge existing patients, several of whom might not have received the required complete treatment.

He further said that only a few luckypatients have the opportunity to get comprehensive cleft care. Even though most patients nowadays get cleft surgery treatment, the outcomes are not certainly reflective of quality care. They remain deprived of the two major aspects -- correction of disfigurement of the face due to poor dental placement and poor speech.

A multi-centric hospital-based study from different cities conducted by the All India Institute of Medical Sciences (AIIMS) as part of an Indian Council of Medical Researchs task force India-Cleft project has shown that around 35 percent of patients show poor outcomes like a hole remaining in palate and complex dental disfigurement after cleft surgery. Moreover, about 70 percent of patients presented with difficulties in speech.

Kharbanda said that to spread awareness of interdisciplinary care and improve the quality of treatment, it is necessary to train different specialists involved in cleft care about the protocols of treatment. The three-day workshop, built as first-of-its-kind, was held in collaboration with the Indian Orthodontic Society recently and has trained over 100 orthodontists from different parts of the country and Nepal.

The workshop highlighted the need for interdisciplinary care and provided the delegates with a complete treatment template starting from antenatal counselling through adulthood and extending beyond marriage in the form of genetic counselling.

It is one of the most significant attempts in the world where a large number of orthodontists were empowered on the holistic management of cleft lip and palate anomalies and enabled them to interact with other specialists from other disciplines like plastic surgeons, cleft surgeons, cleft and craniofacial orthodontists, clinical geneticists, clinical psychologists and speech specialists.

Dr Tradib Jayapal, an eminent orthodontist from Cochin and vice president of the Indian Orthodontic Society, said that treatment protocol of varying standards exists and this programme would lay down a blueprint to start holistic cleft management. He also highlighted the need for a uniform protocol across the country.

Jayapal said that this workshop is a primary step towards achieving the goal. These orthodontists, who have been trained on treatment protocols about cleft lip and palate anomalies, are expected to lead "multidisciplinary cleft care teams" in their districts to provide comprehensive treatment for improving esthetics, treat dental alignments and support speech to help cleft children lead a normal life.