[Global surgery-Challenges in the treatment of children with cleft lip and palate]

Cleft lip and palate is the most frequent malformation in humans that requires surgical correction but is not primarily life-threatening. That is why in many economically not very well developed countries, special surgical care, such as for cleft lip and palate, is not guaranteed at all or is not sufficiently guaranteed, so that numerous aid organizations have been founded for over 50 years to provide help by organizing surgical aid missions. Even if this help seems primarily ethically harmless and very laudable, the lack of rules and instructions unfortunately regularly leads to the fact that legal, ethical and even medical treatment standards are often not observed to the detriment of the affected children.

The necessary principles and prerequisites for surgical aid missions are described in an overview article and from these conceptual and strategic recommendations for the actions of the involved service disciplines are derived. Ultimately, the goal must be not only to surgically help the individual fate but also firstly to treat the functional aspects of the malformation holistically and secondly, to also prioritize the goal of achieving sustainability by competently training the local staff in order to be able to perform such surgery alone in the near future to make such aid missions unnecessary.

Surgical aid missions in Third World countries are a model of success as many hundreds of thousands of children and adults with a cleft lip and palate have been successfully treated; however, unfortunately the sustainable further development of local structures and skills is often neglected. There is also an urgent need to establish general guidelines for surgical aid missions in Third World countries.