A passion for excellence.

The Fifth Congress of the International Cleft Lip and Palate Foundation sponsored by the World Craniofacial Foundation (WCF) was held in Dallas, TX, September 22Y26, 2008. The purpose of this meeting was to present the stateof-the-art in cleft and craniofacial care for developing countries. The purpose of the WCF is to promote and develop global excellence of care in craniofacial surgery for indigent patients through educational programs. This includes seminars such as this one, visiting professorships, mission team teaching, and craniofacial surgery orthodontic fellowship programs. The WCF provides family support and referral of patients to 11 US recognized craniofacial centers that care for indigent patients. A major international effort supports various aspects of team care and provides education of partner dedicated craniofacial teams and centers around the globe on every continent. Most of the international partner center surgeons and other team members participated in this meeting. There were 52 faculty from 16 countries. Additional award winners and special guests brought this total to 71. In attendance were 258 participants from 45 countries, which included Argentina, Belgium, Canada, China, Colombia, Cote d’Ivoire, Germany Ghana, India, Japan, South Korea, Latvia, Mexico, Nigeria, Norway, Philippines, Russian Fed, Saudi Arabia, South Africa, Spain, Thailand, Uganda, United States, and Zimbabwe. There were only 11 registrants from the United States. This was truly an international meeting that was extremely successful from the viewpoint of sharing knowledge and developing new relationships globally. The first day was a premeeting symposium of live surgery performed by the local faculty of the International Craniofacial Institute, Cleft Lip and Palate Treatment Center of Medical City Dallas Hospital. C. Thomas of Oman was invited to demonstrate his open technique of primary cleft lip/nose repair. Kenneth E. Salyer demonstrated primary closed technique of primary cleft lip/nose repair. David Genecov and Raul Barcelo performed additional primary and secondary cleft operations. These were recorded and are included in the CD as part of this special edition of the Journal of Craniofacial Surgery sponsored by the WCF. It was decided that papers could be submitted by the faculty, and the 3 best contest winners of the papers by residents or recent graduates who participated in the meeting. The congress consisted of 203 presentations and teaching courses including invited keynote addresses; general session presentations; panels by the faculty on primary unilateral cleft lip and nose, primary cleft palate, secondary surgery, bone grafting, gingival periosteoplasty, craniofacial surgery, and global cleft and craniofacial care; reports by various countries on the state-of-the-art in their country; free paper sessions; 21 master’s courses; multiple breakout sessions on key topics in bilateral cleft lip and nose; invited special lectures in orthodontics/ growth, speech, and surgery; a breakout session on best free paper competition and secondary cleft lip and nose; special workshops on timely topics; minisymposium on orthodontic approach to the treatment of cleft patients; hands-on workshop on orthognathic surgery sponsored by KLS Martin, session for the Smile Train partners, session for the WCF partners; and many other scientific and social activities. The theme of the meeting was BThe Passion for Excellence in Cleft and Craniofacial Care. [ This meeting was judged by the faculty and attendees repeatedly as one of the best meetings that they had ever attended for cleft or craniofacial care. Smile Train was a major sponsor, underwriting more than 100 of their partners to attend the meeting from around the globe. We took a tremendous amount of care in accurately selecting optimal faculty and presentations to convey the spectrum of approaches in cleft and craniofacial care that could be applied to developing countries. How can we improve the delivery of care in cleft and craniofacial surgery supported by multidisciplinary teams in developing countries? The answer lies in a multifaceted approach to this complex global problem. More than half a million children are born annually with craniofacial and clefting deformities. The long-term answer will evolve from the work on the human genome and related genetic studies. In the meantime, we have millions of children and adults who have received little to no care or poor care. There are a lucky few who are leading normal lives and being productive individuals in our society, because they had the opportunity to receive excellent care. I am sorry to say that those who receive longterm excellent care until they are fully grown are few in number in comparison to the problem. And why do I say that? Because in the United States, where multidisciplinary team care began for the cleft patients, more than 240 teams exist with major differences in their capabilities and the level of care delivered. Considerable fragmentation and the inability to follow patients exist today. Managed care has devastated multidisciplinary dedicated team care. At the state level, the replacement of the state crippled children’s programs by Medicaid has resulted in poor care and decreased support for interdisciplinary care. The solution depends on what happens to the broken health care system that now exists in the United States. A number of long-term studies using different sequencing, techniques, and timing were presented, particularly from Scandinavian countries where socialized medical systems exist, allowing ongoing consistent team care. A number of these studies are included in this special edition. In the opening session, William Shaw, DDS, PhD, University of Manchester, UK, presented a talk entitled, BImproving Cleft Services Based on the World Health Organization’s First Report on Improving Cleft/Craniofacial Services[ (World Health Organization, 2002 Chapter). His presentation covered the following: 1. a better evidence base for selecting optimal treatment protocols, SPECIAL EDITORIAL