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cleft lip, cleft palate

Cleft Lip–Palate Deformities in Western China

Epidemiology, Surgical Reconstruction, and Cost

Travis T. Tollefson, MD; Joseph K. Wong, MD, FRCSC; Jonathan M. Sykes, MD; Wayne F. Larrabee, Jr, MD

Arch Facial Plast Surg. 2006;8:234-239.


A series of 46 procedures (42 patients) was performed on youth with cleft lip–palate deformities in Lanzhou, China. Patients' ages ranged from 6 months to 18 years. There were no short-term complications in this series, which included many advanced cases. The estimated cost per patient was US $1590. Youth with unrepaired cleft lip–palate in western China can be treated in a cost-effective manner.


The early history of cleft lip–palate repair is poorly documented. The first successful cleft lip repair was probably performed as early as 390 BC in China.1 There are more than 300 million births per year in China and (with an incidence of 1 in 700) about 430 000 new cases of cleft lip–palate yearly. The mean cost of repair in Lanzhou is about US $625 and in Shanghai about US $5000. The mean income in Gansu (the poorest province) is about US $125 per year and in Guang Tung (the wealthiest province) about US $625 per year. Most of China's population is rural, and (to our knowledge) there are no accurate statistics on how many youth with cleft lip-palate deformity are treated. This study of a medical mission in Lanzhou documents the case complexity, surgical techniques, cost of reconstruction, and magnitude of the country's need. China is rapidly advancing economically. The wealth of China will eventually enable all of its citizens to receive needed reconstructive surgery. Until then, programs such as the Smile China Project can help close the gap.

In July 2004, a team of US and Canadian surgeons working at Gansu Province Children's Hospital in Lanzhou evaluated and treated patients from remote parts of the Gansu, Qinghai, Ningxia, and Sichuan provinces. Forty-two patients (who ultimately underwent 46 procedures) were selected for reconstructive surgery; their ages and diagnoses are given in Table 1. One hundred thirty-three patients were registered but did not undergo surgery on this trip because of insufficient hospital capacity. Procedures were performed on 4 consecutive days, and surgeons from Lanzhou worked closely with the team. A 2-day seminar was presented by surgeons from the United States, Canada, and China after the surgical reconstructions were completed.


Figure 3. A, Preoperative photograph of an 11-month-old child with a left cleft lip-palate that includes the alveolus. Note the left alar hooding; columellar and caudal septal deflection to the noncleft side; displacement of the alar base laterally, posteriorly, and inferiorly; and asymmetric tip, as represented by the light reflection on the right tip-defining point only. B, Intraoperative view before the left cleft lip repair and tip rhinoplasty. C, Intraoperative view immediately after the cleft lip repair and placement of the triangle fixation suture to enhance the left alar crease and to reposition the lower lateral cartilage. D, Four-month postoperative view.

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