Craniofacial surgery in India: Progress made, but challenges remain

By | September 12, 2014

But they still face daunting challenges in meeting the demand for surgery in patients with craniofacial deformities, cleft palate, and head and neck tumors. “Our special issue presents frontline reports from surgeons striving to make craniofacial surgery more widely available in India,” comments Editor-in-Chief Mutaz B. Habal, MD.

Progress in Developing Craniofacial Surgery in India

The special section includes contributions from surgeons engaged in building craniofacial surgery services and training programs across India. Dr. Ramesh K. Sharma shares his experience in establishing a craniofacial surgery department at the Post Graduate Institute of Medical Education and Research in Chandigarh.

Since opening in 1995, the service has performed about 1,000 major craniofacial procedures, including surgery for infants with congenital skull and facial deformities, cancer resections, and reconstructive surgery in trauma patients. But with a population of 100 million spread across five states, the service can’t keep up with the demand. Dr. Sharma makes recommendations for extending craniofacial surgery capabilities at other Indian teaching hospitals.

Dr. Vaibhav Khanna of Vivekananda Polyclinic & Institute of Medical Sciences and Dr. Divya Narain Upadhyaya of King George Medical University, Lucknow, discuss the future of craniofacial surgery in India. They emphasize the need to develop Indian training programs, presenting two alternative models: Dr. Khanna’s charity hospital and Dr. Upadhyaya’s government-supported university hospital.

Both units provide access to cleft palate and craniofacial surgery to largely impoverished populations, as well as training opportunities for the next generation of surgeons. While intensive effort and increased funding will be essential, the authors conclude, “Craniofacial services and training are now being made available to this part of the developing world.”

Dr. Hemen Jaju of The Gujarat Cancer and Research Institute, Ahmedabad, presents his experience with another category of complex, highly technical procedures: surgery for tumors of the skull base. At least 3,500 skull base tumors occur in India each year — typically diagnosed at an advanced stage.

The Gujarat unit, along with a handful of others, strives to provide a chance of long-term survival for patients with tumors that would otherwise be untreatable. Dr. Jaju’s recommendations for raising the level of skull base surgery in India include creating a national database and consolidated centers of excellence.

Surgeon-in-training Cameron C.Y. Lee and colleagues highlights the experience at Operation Smile’s Cleft Comprehensive Care Clinic in Guwahati. The clinic is shifting from a “mission-based” approach — focusing on cleft palate repair procedures performed by visiting surgeons — to a more comprehensive, developmental approach.

To meet the standard of care in more-developed countries entails long-term follow-up from multiple specialists, including nose and throat surgery, speech pathology, and particularly dentistry. The authors highlight the importance of “cultivating host country independence” — establishing a permanent staff of specialists to provide ongoing care after cleft palate surgery.

“These articles highlight the efforts of dedicated professionals seeking to extend the availability and quality of craniofacial surgery services to the world’s second most populous country,” Dr. Habal adds. “Their efforts reflect our specialty’s commitment not only to develop increasingly refined and advanced surgical techniques, but also to increasing access to needed care for people all over the world.”

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