Translatability of Craniofacial Devices into Low-Middle Income Countries: A Systematic Review

Abstract

Introduction/Purpose: Globally, craniofacial surgery is limited due to disparities in expertise and resources. Lack of treatment results in a negative impact on function, development, and social stigma, increasing the burden of disability-adjusted life years in low- and middle-income countries (LMIC). A systematic review was performed to evaluate craniofacial surgeries requiring craniofacial devices and their translation into LMICs. Materials/Methods: A systematic review via PRISMA guidelines was conducted with keywords for distraction terms OR craniofacial devices terms AND low/middle-income country terms OR reuse/cost/accessibility terms. These terms were applied to databases OVID (Medline), Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Scopus and the register, Cochrane Trials. Records were further screened by abstract by 3 reviewers for inclusion. Results: Two hundred and nineteen articles were identified after screening by abstract. Twenty-six articles met the inclusion criteria. LMICs represented included India, Niger, Nigeria, Vietnam, and Syria. Non-LMICs that provided solutions to increasing access for LMICs included Brazil, Chile, Japan, Mexico, Poland, the Netherlands, South Africa, and Turkey. Costs, resources, the need for multiple surgical interventions or devices, and a lack of surgical expertise were listed as barriers to care. Proposed solutions included capacity building via high-income country (HIC) involvement, 3D modeling and printing, reusing devices, new device implementation, and modification of existing devices. Conclusion: Innovation is needed to overcome healthcare barriers in LMICs. With partnership, support, and resourcefulness, craniofacial surgery can be developed safely in LMICs.