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Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 154-156

Optimizing cleft care during COVID pandemic

Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission25-Nov-2020
Date of Acceptance07-Jan-2021
Date of Web Publication7-Jun-2021

Correspondence Address:
Prof. Devi Prasad Mohapatra
Department of Plastic Surgery, JIPMER, 4th floor, Superspeciality Block, Puducherry 605010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jclpca.jclpca_43_20

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The COVID-19 pandemic has created disruptions worldwide with unprecedented interruption of non-COVID health care. Cleft care services toward children with cleft lip and palate have also been affected worldwide leading to stress among cleft caregivers. The use of remote consultation and therapy finds a definitive application in such situations. We present our method of providing uninterrupted cleft care through remote consultations service during this pandemic.

Keywords: Children's health in pandemic, COVID-19, teleconsultations, virtual cleft care

How to cite this article:
Mohapatra DP, Friji M T, Kumar S D, Chittoria RK, Pathan I, Shijina K. Optimizing cleft care during COVID pandemic. J Cleft Lip Palate Craniofac Anomal 2021;8:154-6

How to cite this URL:
Mohapatra DP, Friji M T, Kumar S D, Chittoria RK, Pathan I, Shijina K. Optimizing cleft care during COVID pandemic. J Cleft Lip Palate Craniofac Anomal [serial online] 2021 [cited 2022 Dec 10];8:154-6. Available from: https://www.jclpca.org/text.asp?2021/8/2/154/317788

Dear Editor,

The COVID-19 pandemic led to an unprecedented situation of lockdown of all services including health-care services, ranging from 21 days to 56 days in almost all parts of the world. While emergency surgical procedures were carried out with precautions and high risk to personal safety of health-care workers, all elective surgeries were deferred in many places.[1] As of now, no clear picture has emerged when and how to resume regular healthcare services. Unprecedented interruption in health-care care services in general and cleft care in particular, due to the COVID pandemic has created stress among the caregivers.[2] Children with cleft lip and palate are a unique population in relevance to this COVID pandemic due to the following reasons.

  1. This population is particularly vulnerable to COVID and its sequelae due to age as well as abnormalities of respiratory mucosal epithelium in association with the cleft condition[3],[4],[5]
  2. Clinical and surgical procedures in facial clefts directly involve the ororespiratory passages so carry a high risk of aerosol generation with risk to health-care workers which is a cause of concern if children are asymptomatic carriers.

Although surgical procedures are deferred, these children and their care givers need nonsurgical support on a regular basis in form of consultation, counseling as well as speech therapy. We analyzed the situation [Table 1] and developed a comprehensive teleconsultation service for children with clefts and their caregivers.
Table 1: Healthcare needs for children with cleft lip and palate

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The specifics of our services were as follows [Figure 1]:
Figure 1: Flow sequence for remote consultation service

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  1. Population already under our cleft care service: They were identified through our cleft database

    Once these children were identified, the service coordinator contacted them proactively and informed them of our service and noted their issues which needed attention. If there were no immediate issues, the parents were encouraged to call back when needed on a dedicated cleft care line which would be attended by the service coordinator. Depending on the nature of issues, the service coordinator informed cleft care consultants, speech language pathologist, or social worker who then called back the parents/caregiver. In situations, where the patient population belonged to low socioeconomic backgrounds (with limited access to data services or ability to pay for calls), the parents were advised to utilize short messaging services to the dedicated cleft care line which was responded by a call back from the service coordinator
  2. Population not previously under our service: Details of the cleft care helpline were released in news media in English and vernacular as well as social media [Figure 2]a and [Figure 2]b. Patients who needed cleft consultations were encouraged to call and register their requirements with the service coordinator, who would then direct the information to cleft care consultant, speech language pathologist, or social worker who then called back the parents/caregivers.
Figure 2: (a and b) Use of social media and newsprint to highlight the availability of remote consultation services (c) Screenshot of Whatsapp group messaging among parents, caregivers and service provider

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The highlights of our service were:

  1. Dedicated single person receiver (service coordinator) on our end who would receive the calls on the cleft care mobile device and forward the information to cleft care team. This helped in providing a personal touch to the service (as opposed to interactive voice response service) so the parents and caregivers would be encouraged to avail the service repeatedly
  2. A WhatsApp (WhatsApp Inc., Android version 2.20.157 WhatsApp LLC, California, USA) group [Figure 2]c comprising of parents/caregivers (with their permissions) of children with cleft lip and palate was made with the service coordinator as the group administrator (admin). This helped the parents to share their issues on a common platform as well as reach out to each other in form of a virtual cleft support group
  3. Speech assessment review as well as speech counseling was carried out through televideo-consultation for children previously registered under our speech therapy program
  4. Children needing physical evaluation (based on prior teleconsultation) were permitted to physically attend the cleft care service on a stipulated date and time with care taken to maintain personal and hand hygiene as well as social distancing norms.

Although there are some technical concerns with these services as, for example, the availability of a stable internet connection as well as smartphones, the benefits actually outweigh the limitations.[6] The cleft care helpline aims to assuage some to the concerns of the affected population. With no respite visible in sight from the COVID situation and possibility of similar such pandemics in future, the cleft teleconsultation help line has the potential to become the new normal in cleft care services.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jean WC, Ironside NT, Sack KD, Felbaum DR, Syed HR. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: A global neurosurgery study. Acta Neurochir (Wien) 2020;162:1229-40.  Back to cited text no. 1
Chew QH, Wei KC, Vasoo S, Chua HC, Sim K. Narrative synthesis of psychological and coping responses towards emerging infectious disease outbreaks in the general population: Practical considerations for the COVID-19 pandemic. Singapore Med J. 2020;61:350-6.  Back to cited text no. 2
Fry-Bowers EK. Children are at risk from COVID-19. J Pediatr Nurs 2020;53:A10-2.  Back to cited text no. 3
Felix-Schollaart B, Hoeksma JB, Prahl-Andersen B. Growth comparison between children with cleft lip and/or palate and controls. Cleft Palate Craniofac J 1992;29:475-80.  Back to cited text no. 4
Kulkarni KR, Patil MR, Shirke AM, Jadhav SB. Perioperative respiratory complications in cleft lip and palate repairs: An audit of 1000 cases under 'Smile Train Project'. Indian J Anaesth 2013;57:562-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
Wright JH, Caudill R. Remote treatment delivery in response to the COVID-19 pandemic. Psychother Psychosom 2020;89:130-2.  Back to cited text no. 6


  [Figure 1], [Figure 2]

  [Table 1]


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