Thursday, January 31, 2013

Asiatic Aesthetic Series 145:Memoirs of a one note smilemaker

the true story of a one note smilemaker who played some guitar  riffs @ le brit embassy pub Sana'a, Yemen in june 2003, led to a plastic surgery charity for an entire nation and parts of East Africa....between 2003 june and 2012 Dec,over 2000 plastic surgery patients were helped free of charge with the help of many wellwishers and donors...

(you tube: Docbona Lotha)
here is one of my favorite sample songs .. 

Yannick Bordeau of Spacetel/France Telecom bassist and Theresa Daly, early supporters of the smile programme

HMA Frances Guy @the brit pub spearheads the plastic surgery charity in june 2003

HMA Mike and Trish UK Res and Andre Lamy of Total France

HMA Mike and Trish Gifford give the charity a structure with France Total and DNO Yemen AS/(Norway) 

Colin Kramer,GM DNO Yemen AS first donor of the charity" that song again,it is my favourite tune..('spanish ballad' solo guitar)

our first two patrons: Anita Culazzo ,Italian Embassy and HMA Frances Guy UK Residence

Tariq AlHaidary, the CEO of Sabafon GSM-a major supporter for hundreds of cleft children and plastic surgery patients across Yemen since 2003

with early supporter Yeal CL of Mount E Singapore 

UK Residence 2004-2006

with Rodney Lim Laser Acupuncture Centre Singapore

Taipei Chang Gung Craniofacial Centre

early supporter Prof KO Lee of NUH Singapore in a recent photo with Sir Roy Calne and others

Vilva of DNO , a steady supporter of all the work 

Stan Hazell of New World Media UK -one of the pillars of the work in Yemen since 2005

                with Philip Chen(student of Noordhoff) @ Chang Gung Craniofacial Taipei- a great teacher

with Prof Sam Noordhoff @ Chang Gung/NCF Taipei

with Singaporean brothers in arms..long term supporters

US Embassy supporters 2009

                                                Smile Train USA
 857 cleft kids sponsored between 2010 jan-2012 dec....a miracle charity @ 41 Madison Ave, NY            

long term supporter Prof John B Mulliken @ Chidrens Craniofacial, Boston
believe  in good things....

Tuesday, January 29, 2013

Asiatic Aesthetic Series 147:Desperate Lives..cleft patients who wait for a lifetime

In Yemen , as in many other poor nations,cleft patients from rural villages often have no opportunity to meet specialist doctors for their cleft lip and palate problems.
Because of the dangers expat plastic surgeons face from kidnappers and terrorists in remote regions of the country ,most patients in these regions remain untreated for almost  a lifetime.
I often come across patients who are well into their 40s- 60s ,with cleft lip and palate deformities.
The only time these unfortunate patients get some specialized treatment is when the nationwide camps are announced once in a while by local health officials.
The cleft palates mostly remain unoperated because adult cleft palates can be very risky to operate.
In order to increase the number of charity operations across the nation, we use the help of local GSM companies who send out millions of text messages informing all villages and towns about the free cleft surgeries.That is one way to lessen the burdens for the cleft population of this impoverished country.

sample pics: adult cleft lip and palate patients in Yemen

Monday, January 21, 2013

Asiatic Aesthetic Series 148:5 minute cleft palate surgery?

all of us are looking for quick fix solutions
but answers to seemingly easy cleft problems are often more complicated than one would imagine
i recently came across a mind boggling claim by a plastic surgeon who felt he could advocate a nouveau 5 minute cleft palate surgery for SMCP (sub mucous cleft palate) and hence this discussion thread with leaders..

some comments... from the boondocks

"SMCP is one of the most complicated problems for a cleft palate surgeon who has to work under spartan conditions without proper nasoendoscopic/videofluoroscopic facilities

one of the challenges (when one diagnoses a child with sub mucous cleft palate )is the approach to treatment

in my given situation I would not know what to do because the traditional  
approach is to wait till the child can speak to see if the patient has VPI...

which causes another problem....if VPI is not treated early ,by the age of one year at least,the chances of VPI in an older child with cleft palate (over 2 years)  in this group will be much higher,although the incidence of SMCP is only about 0.02% and the incidence of VPI is only between 5% to 10 % in SMCP patients

the overt/symptomatic type with varying degrees of VPI may respond differently in different hands;the re op rate can vary and may be quite high (even in Sommerlad's radical muscle repair method )
this is an area which needs more study

The Childrens hospital Boston group reviewed their approaches to this problem from 1984-2009 (single author JM) using muscle retropositioning, Furlows and pharyngeal flap procedures with  varying results -pharyngeal flaps were done only when videofluoroscopy was available(age-4 years plus)..outcomes were worse when the child was over 2 yrs...
( Sub mucous cleft palate and VPI-speech outcomes, Stephen R Sullivan,JBM Cleft Palate-CF Journal Sept 2011,vol48: 5

wow..SMCP which presents as a bifid uvula looks like a simple problem but turns out it is one of the most tricky problems in CP surgery!
simple velar closure is very controversial and surgeons generally do not do it without speech assessment ..."

As you know, VPI rate in submucous cleft palate (SMCP) is only 10%. The traditional recommendation is to wait until child is old enough for speech assessment.Thus, it would be difficult to know whether simple velar closure was of benefit.
However, in a child with SMCP and documented VPI, closure of the uvula will most certainly not improve speech.
Hope all’s well…
John BM
Childrens Boston MA

Mr. Satish Kalra, Chief Program Officer of Smile Train has asked me to respond to your letter regarding sub-mucous cleft palate (SMCP) and  how it should be treated.

Let us first recapitulate what is universally accepted as a fact and these are (1) Not all SMCP require surgery the percentage varies from series to series. (2) A large number do require surgery . (3) To achieve speech without VPI in a SMCP is more difficult than in an ordinary cleft palate. There is a condition called occult sub-mucous occult cleft palate (OSMCP) where Calnan's three criteria are NOT present - The palate looks normal from the mouth but on  naso-endoscopy you see a trough like filling defect on the nasal aspect of the palate. These cases of OSMCP behave like SMCP.

Having said this there is no universally accepted plan of treatment and each exponent believes that what he does is the best.

A.    Conservative School - Do nothing till the child begins to talk and only operate if there is evidence of VPI.

B.     Radical School (David David of Australia "operate on all SMCP at about 7 months.) I accept that I am subjecting 25% of these children to unnecessary surgery. If I create maxillary regression I can treat it effectively. If I land upon with VPI my baby is lost." (Personal communication).

C.     Do a high resolution MRI if there is no good muscle bridging across the defect. Repair at 6-9 months (Vadodara from Oxford)

D.    Do a Furlow in all cases after assessing VPI at 2 years (Philip Chen)

E.     Do a radical palate repair with Jackson - Silverton  pharyngopalsty  which is a modified Orticochea  pharyngoplasty. Ian Jackson just before he retired told me that now he only does a good pharyngoplasty and does not touch the palate.

.. my preference is for A.  No one can fault you for what you choose to do. You must do what you think best.

H.S. Adenwalla
Emeritus Professor of Surgery,Head of the Plastic Surgery, Burns and The Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies Member, Smile Train Medical Advisory Board (South Asia and New York)