Winter 2004 Table of Contents
     
Practicing for Lifesm
Making a Difference, One Smile at a Time
 



Patients and their families wait for treatment at Manuel DeCampos Hospital in Campeche.


Dr. David Hirsche and Dr. Vasiliki Karlis perform cleft lip surgery.

by Vasiliki Karlis, DMD, MD.
Associate Professor of Oral and Maxillofacial Surgery and Director of the Advanced Education Program in Oral and Maxillofacial Surgery

Since 1991, I have participated in annual summer outreach missions to underserved areas in Mexico sponsored by the Universidad Nacional Autonoma de Mexico in Mexico City. Led by the Chairman of the Department of Oral and Maxillofacial Surgery, Dr. Rafael Ruiz Rodriguez, and its Residency Director, Dr. Juan Carlos Lopez Noriega, last year’s trip was a whirlwind, two-day mission to provide care for 76 cleft lip and palate patients at Manuel DeCampos Hospital in the Yucatan City of Campeche, Mexico. During our stay, a remarkable thing happened.

A woman who had had cleft palate surgery at the hospital 17 years earlier returned to the operating room to try to assuage the fears of current patients awaiting this life-changing operation. Her goal was to calm our patients by relating how she had recovered not just from the facial deformities associated with her condition, but also from the psychological scars it can create. Cleft palate patients tend to suffer from depression, panic, and agoraphobia. Watching this now confident young woman, who aspires to become an oral surgeon herself, was a deeply moving experience for me, my senior oral and maxillofacial surgery resident, Dr. David L. Hirsch, Class of 2000, and our team of seven oral and maxillofacial surgeons from the University of Mexico as we worked 18-hour days to treat patients ranging in age from newborns to people in their late twenties.

In Mexico, as in other Latin American countries, a combination of genetic and environmental factors is believed to cause a high incidence of cleft lip and palate deformities, creating a demand for treatment far exceeding available resources. Cleft palate is a birth defect of the mouth. It occurs when the palate does not grow as expected during fetal development. This leaves an opening, or cleft, in the roof of the mouth that may go through to the nasal cavity. Cleft lip is one or more splits in the upper lip. These can range from a small indentation to a split in the lip that may extend up into one or both nostrils. Both conditions can cause a host of related problems, including eating problems, ear infection and hearing loss, speech problems, and dental problems, such as missing, extra, malformed, or displaced teeth requiring dental and orthodontic treatment. Primary cleft lip surgery restores lip function and anatomical features, restores nose form and function, limits growth abnormalities, minimizes scar formation, improves maxillary alveolar segment alignment and, most importantly, minimizes the psychological impact on the patient and his or her family.

Primary cleft palate surgery creates a functional palate, which is crucial for normal speech development, and improves Eustachian tube and middle ear function. Corrective maxillofacial surgery, coupled with plastic surgery and treatment by other specialists to correct related health problems, allows patients to achieve a sense of normalcy and to become better integrated into society.

On our trip to Mexico, I brought sutures, anesthesia tubes, blades, plates, and screws to help augment the limited supplies available at Campeche’s hospital. But outreach missions and supplies alone are not enough. Given the great demand for treatment and the limited amount of resources available in Mexico and other developing countries, NYUCD plans to create a formal exchange program with the Universidad Nacional Autonoma de Mexico, which will allow our residents to travel to Mexico to help treat that country’s large population of cleft palate patients, and Mexican residents to come to NYUCD to learn different treatment methods, such as new approaches to reconstructive and orthognathic surgery. As a matter of fact, last September we had two oral and maxillofacial surgery residents from Mexico with us at NYU. For millions of cleft lip and palate sufferers worldwide, such study- abroad programs hold the key to a profoundly improved quality of life.