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