Approximately one in every 1 000 babies in Africa are born with a cleft lip or cleft palate. The cause of the condition is as yet unknown, but researchers speculate that it could be attributed to environmental and genetic factors. The characteristic gap (cleft) that babies are born with in their upper lip and/or the roof of their mouth can cause several problems, including feeding and breathing problems, frequent ear infections and significant hearing loss, as well as speech problems later in life. To ensure optimal development both in terms of functional aspects and aesthetics, infants with cleft and craniofacial deformities normally undergo corrective surgery during the first year of life. Depending on the severity of the condition, further treatment or additional operations may also be necessary. Although most medical aids in South Africa are willing to cover the procedure to repair a cleft lip or palate (as it is considered a birth defect and a reconstructive operation, rather than a cosmetic one) many families do not have access to a medical aid to cover the costs. Sadly this often leads to these children being hidden away, isolated from their community and denied access to education. In severe cases the condition may even be life threatening if left untreated.

The Facial Cleft Deformity (FCD) Clinic in the Department of Maxillofacial and Oral Surgery of the School of Dentistry at the University of Pretoria (UP) was founded by Prof Kurt Bütow in 1983 and is dedicated to the treatment of children with facial cleft deformities. It is the largest facial cleft clinic in Africa and has treated more than 4 300 patients over the last 33 years. The clinic was awarded the title 'Centre of Excellence' at the International cleft lip and palate congress in Zürich in 2000 and boasts the only African team to obtain the American Cleft Lip Palate Association (ACAP) international team listing since 2011.

One of the team's patients before and after treatment

The clinic follows a multidisciplinary approach in the treatment of patients and has implemented a strict comprehensive therapy protocol for the treatment of children with facial cleft deformities that aims to achieve optimal function and development of the patient's facial growth. A team of medical professionals, which includes maxillofacial and oral surgeons, orthodontists, paediatricians, community health nurses, clinical psychologists, communication pathologists, audiologists, genetic counsellors, paedodontists, prosthodontists,  oral hygienists and dental technicians, work closely together at various stages of the treatment process.

The protocol followed at the clinic requires that surgical interventions take place at specific critical stages during the first year of the patient's life, but ultimately the extent of treatment required depends on how severe the condition is at birth. A small deformity for example, may need only one operation in the first months of life, while a child with a large cleft involving the lip and palate will need several operations and on-going treatment from the team over a number of years. As a result of the surgical success rate and the excellent national and international reputation of the clinic, more than 150 infants, many of whom are from poor socio-economic backgrounds and previously disadvantaged communities, are annually referred to the clinic from both other South African provinces and abroad. Patients without medical aid (about 80% of patients treated at the clinic) are operated on at the Steve Biko Academic Hospital and the UP Oral Health Centre.

Apart from the fantastic work that the FCD team does in terms of changing the lives of children born with cleft and craniofacial deformities, it also offers great opportunities for undergraduate and postgraduate education and research in various medical and related disciplines for students from not only South Africa, but also from other countries across the world. In addition, team members of the clinic regularly engage in various community activities that support their clinical interventions, such as parental support group training, house calls and hospital visits, as well as fund raising for special feeding bottles and plaster taping that is not covered by the National Department of Health. One of the highlights of the FCD Clinic's calendar is its annual year-end function for the children that have been treated there over the years.

All children deserve to lead healthy, happy lives as a valued part of a larger community. The Facial Cleft Deformity Clinic at UP is making today matter by ensuring that this ideal becomes a reality.

Some of the clinic's little patients at the annual year-end function