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Operation Smile

Operation Smile is a global, volunteer-based nonprofit medical service organization founded in 1982 by plastic surgeon Dr. William P. Magee Jr. and his wife Kathy Magee, focused on providing free, safe surgeries and comprehensive care for children born with cleft lip and palate conditions worldwide. The organization delivers not only surgical interventions but also , speech therapy, psychosocial support, and nutritional guidance at no cost to patients, while training and mentoring local healthcare professionals to build sustainable medical capacity in under-resourced regions. With over 6,000 medical volunteers from 60 countries, Operation Smile operates in 37 countries and has performed more than 500,000 life-changing surgeries since its inception (as of 2024). The founding of Operation Smile stemmed from a 1981 humanitarian trip to the , where the Magees witnessed the profound needs of children with untreated cleft conditions and organized their first medical mission the following year in Naga City, treating 100 patients. This initial effort quickly expanded, marking milestones such as the organization's 1989 return to as the first U.S.-based NGO after the war, the 1999 "World Journey of Hope" initiative that operated on 5,300 children across 18 countries, and the 2007 "World Journey of Smiles" that treated 4,086 patients in just two weeks with 1,800 volunteers. Today, Operation Smile addresses a critical gap, as approximately 5 billion people lack access to essential surgical care, through programs like Operation 100, launched in 2025 to strengthen health systems and train 100 surgical teams for timely interventions for cleft conditions. Beyond direct patient care, the organization emphasizes long-term impact by fostering local expertise via surgical training workshops, fellowships, educational programs including the Operation Smile Academy established in , and has empowered thousands of healthcare providers in low- and middle-income countries. It also engages communities through student programs, reaching over 13,000 students in clubs worldwide to raise awareness and support cleft care initiatives. Recognized for its efficiency and transparency, Operation Smile maintains a strong reputation among evaluators, earning top ratings for and program effectiveness.

History

Founding and Early Missions

Operation Smile was founded in 1982 in , by Dr. William P. Magee Jr., a plastic and craniofacial surgeon, and his wife, Kathleen "Kathy" S. Magee, a and clinical social worker. The couple's decision to establish the organization stemmed from their experiences during a medical outreach trip to the , where they encountered hundreds of children suffering from untreated cleft lip and palate conditions due to a lack of access to surgical care in low-resource settings. Deeply moved by the unmet needs, the Magees committed to addressing this global health disparity through volunteer-led initiatives. The organization's inaugural medical mission occurred later that year in Naga City, , organized with a small team of 18 medical volunteers. Over the course of the 10-day program, the team performed cleft repair surgeries on 100 children, marking the beginning of Operation Smile's signature approach to delivering free, high-volume surgical care in underserved communities. This mission not only provided immediate relief but also highlighted the potential impact of short-term, intensive volunteer efforts in regions with limited healthcare infrastructure. In its early years, Operation Smile emphasized volunteer-based medical trips to perform free cleft surgeries for children in developing countries, relying on donations and expertise to sustain operations. Initial challenges included securing funding, coordinating international , and managing the emotional weight of selecting patients amid high demand, which often exceeded available resources. By the end of its first year, the organization had conducted multiple missions, delivering hundreds of surgeries and establishing itself as a nonprofit dedicated to transformative cleft care. These foundational efforts laid the groundwork for future growth into permanent programs worldwide.

Expansion and Milestones

In 1995, Operation Smile opened its first comprehensive cleft care center in Duitama, , transitioning from short-term surgical missions to establishing permanent facilities for ongoing treatment and support. This marked a pivotal shift toward sustainable, community-based care in regions with limited access to specialized services. The organization expanded internationally by founding affiliate entities in the late and early , including Operation Smile in 1999, Operation Smile in 2001, Operation Smile Italia Onlus in 2000, and Operation Smile in 2003, with a strong presence in dating back to its first mission there in 1989 and formal operations growing through the early . These foundations facilitated fundraising, volunteer recruitment, and localized program coordination, enabling broader global reach. Key milestones include surpassing 200,000 free surgeries by the early 2010s, reflecting the scale of volunteer-driven efforts across multiple continents. By the 2010s, operations had grown to more than 60 countries, though the current focus is on 37 countries with established programs. In 2023, the organization reported 32 operational care centers worldwide, providing year-round comprehensive services. Institutionally, Operation Smile hosted its first major global summit on medical standards in , in 2007, convening experts to enhance surgical safety and training protocols. More recently, in 2024, it trained over 6,500 healthcare to strengthen local capacity in low-resource settings. In March 2025, the organization unveiled its "Operation 100" blueprint, a strategic plan to build a self-sustaining surgical and expand to essential care globally by 2035.

Programs and Services

Surgical Missions

Operation Smile's surgical missions form the cornerstone of its operational model, consisting of short-term, volunteer-led medical trips designed to deliver cleft lip and palate repairs in resource-limited settings. These missions typically span 7 to 10 days and involve multidisciplinary teams of 10 to 30 volunteers, including plastic , anesthesiologists, nurses, pediatricians, dentists, speech pathologists, and support staff such as biomedical technicians and psychosocial providers. Teams are selected based on expertise and mission needs, with a focus on maintaining minimum staffing ratios, such as one and one anesthesiologist per operating table, to ensure safe care delivery. The process begins with pre-mission assessments, conducted every two years, to evaluate facilities, equipment availability, and partnerships with host hospitals for resources like intensive care units. Upon arrival, teams perform on- screenings, often evaluating 200 to 300 candidates to prioritize those suitable for based on health status, age, and nutritional readiness. Selected undergo elective cleft repairs in operating rooms equipped with transported machines, devices, surgical instruments, and emergency kits; daily operations are limited to 10 hours, with teams capable of completing up to 15 to 20 procedures per day across multiple tables. Post-operative care includes in a recovery area, ward oversight, and follow-up evaluations at 4 to 7 days, with longer-term check-ins at 6 to 12 months coordinated through partners. These missions have evolved significantly since their ad-hoc beginnings in the 1980s, when teams relied on basic supplies carried in luggage, to a standardized established in the early 2000s following safety reviews. Post-2002 protocols incorporated rigorous volunteer screening, advanced like and end-tidal CO2, and systematic equipment transport, often via specialized logistics, while emphasizing collaboration with local governments and hospitals to build sustainable capacity. Medical Global Standards, first developed in 2006 and revised in 2010, 2014, and 2020, guide all aspects of mission execution to prioritize and quality outcomes. As of 2024, Operation Smile had provided life-changing surgical procedures and comprehensive care to over 500,000 people through these missions and related programs, conducted annually in more than 30 countries across 177 programs in the prior year. Missions integrate briefly with permanent Smile Centers for ongoing follow-up care, ensuring continuity beyond the short-term intervention.

Training and Capacity Building

Operation Smile's training and capacity building efforts emphasize educational programs designed to empower local healthcare providers in low- and middle-income countries, fostering self-sustaining cleft care systems and minimizing dependence on international volunteers. These initiatives target surgeons, nurses, anesthesiologists, and other specialists through structured workshops, fellowships, and certification courses focused on cleft lip and palate repair techniques, pediatric care, and comprehensive patient management. By prioritizing , the organization aims to enhance surgical safety, early intervention, and long-term health outcomes in underserved regions. Key programs include the Cleft Surgical Training Program (CSTP), which provides intensive mentorship for local surgeons to master advanced cleft repair procedures, with cohorts such as the 2023 group comprising 17 participants from nine countries. The Operation Smile offers an online platform with webinars, virtual courses, and mentorship opportunities tailored for cleft care professionals, covering topics from protocols to non-operative support like nutrition and speech therapy. Additionally, fellowships such as the Global Surgery Fellows program equip emerging medical leaders with expertise through immersive experiences in , policy, and clinical skills development. A six-month hybrid certificate program launched in 2025 further supports surgical leaders in transforming local care systems. In March 2025, the organization launched Operation 100, a blueprint to train 100 surgical teams and establish 100 sites for sustainable cleft care by 2035. These efforts have trained thousands of healthcare workers annually, exemplified by over 6,563 professionals in across operative and non-operative disciplines, contributing to sustainable capacity in 37 countries where Operation Smile operates. Since its founding, the has built local expertise to address critical shortages, enabling communities to provide ongoing cleft care independently. Hands-on mentoring occurs during in-country programs, complemented by virtual simulations via the and the dissemination of publications outlining best practices in safe and team-based care. In September 2025, Operation Smile introduced a groundbreaking program, co-created with Next Conversation Consulting and The Training Associates, which demonstrated up to 192% growth in participants' capabilities through targeted skills training and mentorship. This initiative underscores the organization's commitment to cultivating high-impact leaders who can drive systemic improvements in global cleft care.

Smile Centers and Comprehensive Care

Operation Smile operates a network of permanent care centers that provide year-round treatment for individuals with cleft conditions, with 35 such centers established in 20 countries as of 2022. These facilities, often referred to as Smile Centers or Comprehensive Care Centers, are located in regions with high needs, including , , and , where they deliver ongoing support to patients and families. By 2024, the organization expanded to over 60 ongoing comprehensive care locations worldwide, enhancing access to sustained healthcare services. The centers embody Operation Smile's model of comprehensive cleft care, extending far beyond initial to address multifaceted needs. Services include programs to combat common among infants with clefts, speech therapy to improve communication and , dental and orthodontic care for oral health, and family counseling through support that fosters emotional . This holistic approach ensures patients receive integrated treatment tailored to their physical, nutritional, psychological, and developmental requirements, promoting long-term well-being. The development of these centers began with the opening of the first facility in 1995 in Duitama, Colombia, marking a shift from short-term missions to permanent infrastructure for continuous care. Over the decades, the network has grown in alignment with global health equity objectives, with a commitment to serve the next 1 million patients by 2032 through enhanced surgical and supportive services across 37 countries. A distinctive feature of the Smile Centers is their reliance on local staffing, comprising professionals trained by Operation Smile to deliver culturally appropriate care, which sustains operations and builds community capacity. The organization also conducts research on long-term patient outcomes, evaluating the effectiveness of comprehensive interventions in improving and reducing secondary health issues associated with cleft conditions. In 2024, Operation Smile intensified focus on non-surgical interventions at these centers, prioritizing to correct alignment issues and expanded psychosocial support programs to address and challenges faced by patients and families. These efforts complement surgical follow-up, ensuring a seamless of care that empowers local health systems.

Organizational Structure

Headquarters and Global Presence

Operation Smile was established in Norfolk, Virginia, in 1982 as its original headquarters location. In 2007, the organization relocated its global headquarters to , to accommodate expanded facilities, including a 75,000-square-foot designed to support administrative, training, and logistical functions. The current headquarters is situated at 3641 Faculty Boulevard, Virginia Beach, VA 23453, serving as the central hub for operations. The organization maintains a U.S.-based structure with approximately 600 staff members dedicated to coordination and support. It operates through a network of six representative offices in international locations, with regional presences in , , and to facilitate local operations and partnerships. Globally, Operation Smile has a footprint in more than 40 countries, delivering services through short-term medical missions, care centers, and hospital collaborations, supported by over 6,000 volunteers from 60 countries. Administratively, the organization is governed by a , including key figures such as Chairman Robert James Boyd III and and CEO Kathleen S. Magee, who oversee strategic direction and worldwide coordination. Medical oversight is provided through roles like William Magee III, ensuring standards for global programs. As of 2025, Operation Smile holds a four-star rating from , reflecting strong accountability and impact in its Virginia Beach-headquartered operations.

Partnerships and Collaborations

Operation Smile has forged strategic alliances with international organizations, governments, and private entities to expand its reach in providing cleft surgery and comprehensive care, particularly in underserved regions. These partnerships facilitate access to remote areas, enhance training programs, and mobilize resources for sustainable health system improvements. Among its key collaborators, Operation Smile partners with the (WHO) through the Coalition to Address the Burden of Congenital Conditions, under WHO’s Department of Maternal, Newborn, and and Ageing, to improve care for children with congenital anomalies like cleft conditions. This alliance, alongside organizations such as Global Arch and Children’s HeartLink, focuses on policy advocacy and capacity building to reduce the global burden of such conditions. Additionally, Operation Smile has collaborated with on initiatives supporting children's health rights and surgical access. Partnerships with local health ministries in countries across and enable on-the-ground implementation, including joint efforts to integrate cleft care into national health systems and secure permissions for surgical missions in remote communities. A longstanding collaboration with Rotary International dates back to the 1980s, with formalized efforts since 1993, providing logistical support such as patient transportation, food, and facility access for surgical programs. In Mexico, for instance, Rotary aids in hosting missions by covering travel and meals for patients and families, enabling Operation Smile to treat thousands in partnership with local Rotary clubs. This ongoing relationship has been instrumental in regions like Latin America and has extended to joint humanitarian projects in the Philippines and elsewhere. In 2024, Operation Smile formed an alliance with Beast Philanthropy, the nonprofit arm of , to produce a video documenting a surgical program in , . Released in February 2024, the video reached over 22 million subscribers, raising awareness and funds to support cleft surgeries and care, while inspiring new donor engagement. Operation Smile maintains academic ties with universities for research and training, including the ’s Institute on Inequalities in Global Health, where fellows conduct studies on genetic and environmental factors in cleft conditions. The organization’s Global Surgery Fellowship, established in 2010, trains surgeons from low-resource settings through university-affiliated programs, fostering research on surgical delivery and barriers to care. Corporate sponsors further bolster these efforts; AriZona Iced Tea donated 5% of net sales from its 2009 Kidz Tea line to fund missions, while Lay’s “Smile with Lay’s” campaign, running annually since 2018, has contributed over $1 million through chip bag sales featuring smiling faces, directly supporting surgeries for children with clefts. These collaborations have yielded expanded access to care, including co-funded initiatives like the partnership with the College of Surgeons of East, Central and (COSECSA) since 2021, which trained ’s plastic surgeons from two to five and established regional treatment hospitals for cleft care. In and , joint hospital partnerships in countries such as and the have enabled year-round care centers, treating thousands through shared funding and expertise. Following the failed 2011 merger attempt with , Operation Smile has prioritized such independent alliances over consolidations, maintaining operational autonomy while scaling impact.

Controversies

Safety Criticisms and Responses (1999-2002)

Between 1998 and 1999, Operation Smile faced significant scrutiny following the deaths of four children during or shortly after surgical missions, including cases involving complications in . One notable incident involved a two-year-old girl in who died during a cleft-lip procedure after receiving anesthesia from a volunteer anesthesiologist who later reported feeling overworked and underprepared for the conditions. These events contributed to a total of 16 patient deaths since the organization's founding in 1982, prompting investigations and media coverage that highlighted broader safety concerns. Critics accused Operation Smile of inadequate patient screening, relying on overworked volunteers without sufficient oversight, and emphasizing the volume of surgeries and publicity over patient safety. Reports described "assembly-line medicine" practices, where missions prioritized high numbers of operations in short periods, leading to complications like infections and anesthesia errors in resource-limited settings such as China and other countries. Medical professionals and former volunteers raised alarms about the lack of rigorous credentialing for participants and insufficient pre-operative assessments, arguing that these factors endangered vulnerable children. In response to the 1999 criticisms, Operation Smile commissioned an internal review in late by independent lawyer F. Bradford Stillman, which identified organizational flaws including poor record-keeping and oversight gaps, though no widespread financial misconduct was found. The organization publicly acknowledged these issues four months later and committed to reforms, including the creation of a position to oversee volunteer credentials and safety standards. By 2002, Operation Smile had implemented enhanced safety protocols, such as mandatory medical credentialing for all volunteers, comprehensive risk assessments before missions, and reductions in mission sizes to allow for more thorough patient evaluations and rest for staff. These changes also strengthened board supervision of medical teams and emphasized ongoing training to address previous shortcomings. Over the longer term, the organization shifted focus toward capacity-building programs that prioritized sustainable, high-quality care, contributing to improved surgical outcomes in subsequent missions.

Failed Merger with Smile Train (2011)

In early 2011, Operation Smile and Smile Train announced plans to merge in order to consolidate their overlapping efforts in cleft lip and palate care, reduce administrative duplication, and amplify their collective impact on providing surgeries to children worldwide. The joint announcement, issued on February 14, 2011, highlighted the organizations' shared history of delivering over 750,000 surgeries and emphasized building on each other's strengths for greater efficiency. The proposed merger quickly unraveled due to fundamental disagreements on structures, roles, and strategies. Key conflicts centered on control over financial assets and decision-making authority, with Smile Train's chairman Charles B. Wang seeking oversight of the majority of the organization's $160 million in assets and lifetime board tenure, which alienated donors and board members. Widespread opposition from Smile Train's donors, three dissenting board members, and its entire medical advisory board led to the abrupt termination of the deal on March 7, 2011, just weeks after the initial approval. Following the collapse, the organizations settled lingering obligations in 2013, with Operation Smile agreeing to pay $4 million to Smile Train's subsidiary, Stop Cleft International. This payment was recorded as a in Operation Smile's for the ending June 30, 2013. The failed merger intensified the existing between the two groups but also spurred Operation Smile to undertake internal , including transitions and a sharpened emphasis on independent program expansion.

Financial Overview

Revenue, Expenses, and Efficiency

Operation Smile's revenue is derived primarily from contributions by individuals, foundations, and corporations, supplemented by in-kind donations such as medical supplies and services. For fiscal year 2024 (ended June 30, 2024), total revenue reached $100.35 million, reflecting growth from mission sponsorships and corporate partnerships, including initiatives like golf outings that raised over $4 million. For the same year, expenses totaled $97.32 million, with program services accounting for approximately 84% ($82.07 million). In the early 2020s, annual revenue varied, with FY2022 at $91.51 million and FY2023 at $95.07 million (cash basis), reaching $100.35 million in FY2024, supporting expanded global operations. Expenses are allocated across program services, fundraising, and administration, with a focus on surgical missions, training, and . In 2023 (ended June 30, 2023), total expenses amounted to $136.99 million, with 78% ($107.26 million) directed to programs, 17% ($22.90 million) to , and 7% ($9.31 million) to , including in-kind contributions valued at $53.81 million. For 2022, expenses totaled $77.69 million, with approximately 60% allocated to programs based on expenses, though including in-kind elevates the program share. Historically, in 2010, ranked Operation Smile as the 5th least efficient large U.S. due to high costs relative to program spending at the time. Efficiency metrics have improved in recent years, with Charity Navigator awarding a four-star rating (91% score) as of fiscal year 2023 for strong accountability and finance practices, including a program expense ratio of 60.65% on a three-year average (cash basis). The Better Business Bureau's Wise Giving Alliance also affirmed compliance with 20 accountability standards in 2023, highlighting fundraising efficiency at $0.15 raised per dollar spent. Following the failed 2011 merger attempt with Smile Train, which drew scrutiny to financial practices, Operation Smile enhanced transparency through annual audited financial statements and detailed reporting. The 2024 Year in Review underscores ongoing investments in capacity building to optimize resource use for long-term impact.

Leadership and Compensation

Operation Smile was co-founded in 1982 by Dr. William P. Magee Jr., a and craniofacial who served as the organization's initial CEO and later as CEO Emeritus, and his wife, Kathleen S. Magee, a , social worker, and educator who has held the position of President and CEO since the organization's inception. In 2016, Dr. Magee transitioned from his private medical practice in , to dedicate his full efforts to Operation Smile, while maintaining his role on the . The Magees' leadership has emphasized global medical missions and , with Kathleen S. Magee overseeing strategic direction and operational expansion as of 2025. The board of directors, which provides governance and oversight, is currently chaired by Robert James Boyd III, Chairman and President of Boyd Steamship Corp., with Dominic M. Gioffre Jr., D.D.S., serving as Vice Chairman. Other prominent board members include Christopher Anderson as Treasurer and Chief Executive Officer of Crossroads Technology, as well as William Magee III, D.D.S., M.D., who holds the position of Chief Medical Officer and focuses on clinical standards and program quality. The executive team comprises specialized roles such as Kristie Magee Porcaro as Chief Strategy and Development Officer, responsible for aligning global partnerships and fundraising strategies, and Scott McDonald as Global Chief Development Officer, appointed in April 2025 to lead development efforts and donor relations. These leaders report to the CEO and board, ensuring integration of medical, operational, and philanthropic activities. Executive compensation has been a point of public scrutiny, particularly regarding its proportion to mission-related expenditures. In the fiscal year ending June 2011, Dr. William P. Magee Jr.'s compensation as CEO totaled $350,000 in base salary plus $27,915 in other reportable compensation. By the ending June 2023, total compensation for key officers, directors, trustees, and the top five highest-paid employees exceeded $4 million, with Dr. William P. Magee Jr. receiving $439,612 and Kathleen S. Magee receiving $219,806 in the subsequent ending June 2024, including benefits and allowances. These figures reflect adjustments for organizational but have drawn for contributing to administrative costs, prompting calls for greater in nonprofit executive pay. In response to earlier operational controversies, including safety concerns from 1999 to 2002, Operation Smile underwent significant reforms in 2000, implementing recommendations from an independent legal review that enhanced medical protocols, volunteer screening, and independent board oversight to improve and . As of 2025, the organization maintains a nine-member board, with 33% of members receiving compensation, which falls short of some accountability standards recommending no more than one compensated board member. Despite such concerns, Operation Smile demonstrates strong overall , meeting 19 out of 20 standards for accountability as evaluated by the Better Business Bureau's Wise Giving .

Impact and Recognition

Achievements and Global Statistics

Since its founding in , Operation Smile has provided free cleft surgeries and comprehensive care to over 500,000 patients worldwide. This cumulative impact includes screening and treating individuals in resource-limited settings. In 2024, Operation Smile conducted programs in 31 countries, delivering surgical care to 15,517 patients and broader comprehensive care—including , speech , and dental services—to over 86,000 individuals. The organization trained 6,563 workers that year, enhancing local capacity through workshops and leadership programs in over 25 countries. Looking ahead, Operation Smile's Operation 100 initiative aims to equip and train 100 surgical teams in 100 district hospitals by 2032, targeting access to care for 1 million additional patients across 37 countries. Operation Smile has received notable recognitions for its contributions, including a special award from the Vietnamese government in 2025 to co-founder for 35 years of service in the country, where the organization has pioneered cleft care since 1989. It also leads in research on cleft care best practices, developing global standards for safe surgery and comprehensive treatment through initiatives like thought leadership publications and collaborations with health ministries. Beyond direct medical interventions, Operation Smile's work has contributed to reducing associated with cleft conditions in affected communities by integrating support and awareness programs that promote inclusion and emotional well-being. In March 2025, the organization unveiled a blueprint under Operation 100 to transform global surgical access, focusing on sustainable local systems to serve nearly 500 million people within a two-hour radius of equipped facilities. Annual reports document these outcomes, highlighting long-term health improvements such as enhanced nutrition and speech development.

Media, Culture, and Endorsements

Operation Smile has received significant media attention that has helped amplify its mission to provide cleft lip and palate surgeries to children worldwide. In the early , the organization was featured in The Facemakers, a co-production involving the and , which followed surgical missions in the and highlighted the transformative impact on children's lives. More recently, aired a 2018 segment hosted by , showcasing volunteer efforts and the organization's role in delivering life-changing surgeries to children with cleft conditions. In , Operation Smile's work has inspired narratives centered on hope and resilience. The 2007 book A Journey of Smiles, published by the organization itself, chronicles personal stories of transformation through its programs, emphasizing the emotional journeys of patients and volunteers. These depictions have contributed to broader cultural awareness of cleft care challenges, though specific songs or films directly inspired by missions remain limited in documented examples. Celebrity endorsements have played a key role in raising the organization's profile. Actress was honored with the Universal Smile Award at Operation Smile's 2016 gala in , where she spoke about the charity's personal significance and its global impact on children with facial deformities. , known for her roles in , has served as a longtime ambassador and member of the Board of Governors, hosting direct-response television programs and participating in missions to countries including , , and to promote cleft surgeries. In 2024, YouTuber , through his Beast Philanthropy initiative, partnered with Operation Smile to produce an emotional video filmed during a mission in Puebla, Mexico, which reached tens of millions of viewers and spotlighted the need for accessible surgical care. Co-branding efforts with consumer brands have further extended visibility through product tie-ins. In 2017, Sephora China committed to supporting 1,000 children with cleft conditions by year's end, integrating donations into its beauty retail operations. Lay's potato chips launched multiple campaigns starting in 2018, featuring smiling faces on packaging—including that of Operation Smile co-founder Kathy Magee—and pledging up to $1 million in donations to fund surgeries. AriZona Iced Tea introduced Kidz Teas in 2009, with a portion of sales benefiting the organization to support pediatric cleft care initiatives. Hasbro has donated Mr. Potato Head toys, including custom plush versions valued at $250,000, to comfort children during medical screenings and missions. These media features, cultural representations, and endorsements have significantly boosted donations and public awareness, as evidenced by the collaboration, which not only funded surgeries but also educated a vast online audience about cleft conditions and the importance of timely interventions.

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