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"Presurgical Infant Orthopedics in Low-Income and Middle-Income Countries: Demographics, Access, and Treatment
Daniela Y S Tanikawa1, Puneet Batra2, Janet Pandan3
1Cleft Lip and Palate Team, Menino Jesus Municipal Hospital, Cleft Lip and Palate Center, Sabará Children's Hospital, Smile Train's Latin America Medical Advisory Council, São Paulo, Brazil.
Insights
Presurgical infant orthopedics (PSIO) effectively reduces cleft severity and improves nasal symmetry in low- and middle-income countries (LMICs). This study highlights PSIO
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Global Health Initiatives
Background:
- Presurgical infant orthopedics (PSIO) is standard in high-income countries for cleft care.
- Its implementation and effectiveness in low- and middle-income countries (LMICs) are less understood.
- This study examines PSIO in 5 LMIC centers.
Purpose of the Study:
- To assess the feasibility, accessibility, and effectiveness of PSIO in LMICs.
- To compare anthropometric outcomes of different PSIO techniques.
- To evaluate the impact of PSIO on surgical timing.
Main Methods:
- Retrospective multicenter analysis of Smile Train Express (STX) data from Brazil, Mexico, India, Vietnam, and the Philippines.
- Collected data on PSIO initiation, completion, follow-up, and surgical timing.
- Analyzed nostril width ratio (NWR) and columellar angle (CA) for treatment effectiveness.
Main Results:
- PSIO significantly reduced cleft severity and improved nasal symmetry across all centers.
- No significant differences in NWR and CA were found between PSIO techniques.
- PSIO coverage varied (16%-50%), and PSIO patients had earlier surgery.
- Treatment initiation and completion timelines varied by center.
Conclusions:
- PSIO is an effective intervention for cleft care in LMICs.
- Alternative PSIO techniques yield comparable outcomes to nasal alveolar molding (NAM).
- Optimizing cleft care in resource-limited settings requires improved referral pathways and public health partnerships.
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.
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