The World Cleft Coalition (WCC) is an alliance of International Non-Governmental Organizations (NGOs)
that work in the field of cleft lip and palate*. Our goal is to encourage international
collaboration in the development of an agreed set of globally-recognized minimum core practice
guidelines and best practice guidelines.
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- Safety in all aspects of cleft care, especially surgical, is essential
and cannot be compromised.
- Comprehensive care using a multidisciplinary team approach provides for
the best possible cleft care. A multidisciplinary cleft team should include, as a minimum,
healthcare professionals in the areas of anesthesiology, dentistry, nursing, orthodontics,
pediatrics, psychosocial care, speech-language pathology, and surgery, with overall coordination
- Within the range of international treatment programmes, all healthcare
professionals, visiting or practicing locally, must have recognised credentials and expertise
with proven experience in their field of practice. Professionals must have active licensure in
their country of residency and, if required, in the host country.
- Cleft care should always support and strengthen local capacity for
delivering comprehensive cleft care.
- Medical care should always be delivered at the highest professional
level, taking the variability of local circumstances into consideration.
- Services must be offered to patients in a culturally appropriate manner
and regardless of race, ethnicity, religion, socio-economic background, gender, physical and
mental ability or community resources. The aim is always to enable patients to become fully
integrated in their societies and to enjoy the same opportunities as their peers.
- It is important for all health care professionals to understand their
responsibilities when treating and managing children and young people. Articles of the UN
Convention on the Rights of the Child (1989) should underpin all policy and practice in child
RECOMMENDED PRACTICE FOR ENSURING SAFE, COMPREHENSIVE AND SUSTAINABLE CLEFT CARE
Minimum Core Standards
- Provision of safe surgical care includes careful
pre-operative evaluation, safe surgical and anesthesia management, and optimal
post-operative care with properly trained and equipped healthcare professionals
following agreed protocols for emergency care and anesthetic complications.
- Surgical safety checklists should be used and adapted as
- Every effort should be taken to ensure the safety of the
patient in all aspects of his/her medical care.
- Outcomes should be reviewed and analyzed on a regular basis.
- Complications and adverse events should be documented,
reviewed periodically by the team and measures should be put in place to minimize
- Complete and accurate records should be kept and made
available to the local medical team.
- Routine assessment of outcomes and complications should be
in place with suggestions to improve care. Protocols should be available to maximize
safety and optimize outcomes.
Patient Education Cont.
- Patients and their families or caregivers should be provided
with appropriate education and information about their diagnosis and treatment. This
should include feeding, speech, orthodontics, dental care,
psychological needs, surgery, post-operative care and long-term follow up, and any
- Fully informed and culturally appropriate consent should be
obtained prior to the delivery of any care.
- Patient privacy should be respected and in line with
internationally accepted ethical codes.
- Patients should have clear information about all healthcare
professionals delivering care.
- Rigorous anaesthetic and surgical safety standards should be
applied pre- operatively by qualified persons to ensure patient safety and minimize
- Screening should be carried out before any type of
- Screening systems should be established to ensure safe
intervention and where deemed unsafe a pathway should be made available to
Patient Follow Up
- Provision for post-operative follow up care and management
of complications must be included in the treatment program.
- Patients should have clear information about the healthcare
responsible for their follow up and any planned or needed subsequent treatment(s).
- Follow up care that includes all subspecialists is optimal.
- Treatment programs should be multidisciplinary, addressing
all aspects of the patient’s care. The aim is to enable patients to become
fully integrated into their societies and to enjoy the same opportunities as their
peers. Treatment programs should also address the family’s needs and provide
community education regarding cleft care from infancy through adulthood.
- A multidisciplinary cleft team should include, as a minimum
Anesthesiology, dentistry, nursing, orthodontics pediatrics, psychosocial care,
speech-language pathology, and surgery, with overall coordination provided.
- In addition to the minimum core team members (above), the
team should demonstrate access to healthcare professionals including, but not
limited to, audiology, pediatric and restorative dentistry, genetics,
otolaryngology, psychology, and social work.
Partnership with host nation and professionals
- Involvement, agreement and cooperation of host nation, local
healthcare professionals and applicable government agencies should be established to
ensure sustainability of healthcare services.
- There should be a commitment to building medical and other
cleft treatment capacities through training, provision of equipment, and ongoing
Training for Sustainability and Local Capacity
- Training plans should include engagement with host nation
professionals and must ensure that training is appropriate given the local
structures and resources.
- Any training opportunities should be provided under the
senior healthcare professional’s strict and continuous supervision.
- Programs should seek ongoing exchange of knowledge with
local healthcare providers to support the establishment of local capacities that can
deliver high quality comprehensive care.
- A multidisciplinary approach should be projected to the
local hosts as the best model of care and efforts to train all specialties involved
in cleft care should be established.
- Innovative EBP & technology approaches for training,
provision of comprehensive care, and/or ongoing treatment should be considered as
*American Cleft Palate Craniofacial Association, European Cleft Organization, Global
Smile Foundation, Operation Smile, Smile Train, Transforming Faces March 2019