Do Pedi surgeons do cleft pallet repairs?

[Docgeorge]

Or does that go to the ENT and plastics guys?

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[killahB]

Or does that go to the ENT and plastics guys?

I think its primary plastics people, but certain ENT programs train you in it too.
Then again, even if you do G-surg, you could take part in operation SMILE- where people go to various countries and do nothing but cleft lips/palates for a few weeks a year. Seems like thats a good way to go, from what some people tell me.
I'm applying into ENT, and if i end up at a program that doesn't do cleft work, I'm going to still try and learn it through the operation SMILE route.

 

[aphistis]

Or does that go to the ENT and plastics guys?

Let's not forget the OMS folks.

 

[Idiopathic]

We always had plastics guys talk to us about it...they remarked how it was a way they could 'give back'.

 

[OzDDS]

Let's not forget the OMS folks.

Very true... There shouldn't be many scope of practice fights concerning this one. Can't get much more "oral" than the lip/palate. Plus It's not like these are big $$ procedures anyways considering most of the need for this is among poor communities in China and India. So I can't see the plastics guys trying to yank this one from us like facelifts and occuloplastics because we're impeding their cashflow.

 

[surggal]

in any major academic center, plastics does the cleft repairs. It's the mainstay of pediatric plastic surgery--that and polydactyly/syndactyly reconstruction. OMFS assists in palatal expansion etc. in preparation for the palate repair. orthodontists and speech therapists are important as well.

 

[OzDDS]

in any major academic center, plastics does the cleft repairs. It's the mainstay of pediatric plastic surgery--that and polydactyly/syndactyly reconstruction. OMFS assists in palatal expansion etc. in preparation for the palate repair. orthodontists and speech therapists are important as well.

Ortho does does lots of of palatal expansion work, and prostho fits temp obturators, etc. But Oral and Maxillofacial surgeons still do loads of lip/palate repair.

 

[OzDDS]

It's the mainstay of pediatric plastic surgery

It's also the mainstay of pediatric maxillofacial surgery.

 

[aphistis]

in any major academic center, plastics does the cleft repairs. It's the mainstay of pediatric plastic surgery--that and polydactyly/syndactyly reconstruction. OMFS assists in palatal expansion etc. in preparation for the palate repair. orthodontists and speech therapists are important as well.

"Any major academic center" is a pretty sweeping generalization. Unless you're a lot more familiar with OMS around the country than I think you are, you might want to double-check your facts on that one.

 

[surggal]

i think it probably depends on where you're from. perhaps it's an east coast phenomenon.

 

[toofache32]

It's definately a region thing. My OMFS program does a fair amount of primary clefts, but in general the Plastics guys around here do more. I think it's funny that the Plastics guys don't b!tch about us doing clefts because the reimbursement is so low...and the same is true for trauma. It's only the cash cow like cosmetics that they fuss about.

 

[droliver]

I think in general, most of the largest tertiary craniofacial centers are Plastic Surgery staffed with a trend towards more centralization of these procedures to higher volume centers to be done by high volume specialists. Fewer graduates from any of the specialties will be doing these in the near future as this plays out

 

[OzDDS]

I think in general, most of the largest tertiary craniofacial centers are Plastic Surgery staffed with a trend towards more centralization of these procedures to higher volume centers to be done by high volume specialists. Fewer graduates from any of the specialties will be doing these in the near future as this plays out

Can you give more details.. what do you mean exactly?

 

[maxheadroom]

It's pretty simple, really. Most cases of cleft lip/palate are being referred to high-volume centers where a small group of high-volume surgeons do the cases. In most places where I have experience, clefts are done exclusively by Plastics with ENT for tubes and OMFS sometimes coming in on bone-grafting. At one institution, the craniofacial director did all of the bone-grafting on her own.

Additionally, at all of the programs that I've seen, clefts are sought-out cases by both the residents and faculty. I'd rather scrub a cleft than a reduction or an aug.

 

[droliver]

Additionally, at all of the programs that I've seen, clefts are sought-out cases by both the residents and faculty. I'd rather scrub a cleft than a reduction or an aug.

Max outlined my view in a little more detail. The state systems for crippled children's clinics are more and more integrated clinics making it difficult for people to "dabble" in doing these kinds of cases anymore, encouraging a system where a very few people will do most of these. Alongside this consolidation has been the reduction in reimbursements 75-80%+ for these procedures which is a strong disincentive for everyone. So practical hurdles + low pay = little interest.

In contrast to Max, I've had little interest in these kind of cases during training because I know I will never do one in practice

 

[maxheadroom]

OK, so my bias towards a craniofacial fellowship is showing . . . mea culpa.

Good to see you around, Ollie. I hope you're enjoying your chief year.

 

[Docgeorge]

thanks for the reply guys...

I was just currious. I'm really interested in doing charity work in 3rd world countries esp on kids. Would organizations like operation smile take GS or do they just want ENT/plastics/OMS guys for this kind of stuff.

 

[maxheadroom]

I've heard from some people that they will take GS and from some people that they don't. Several of my faculty work with Op Smile and the PRS chiefs have the opportunity to go if they're interested. You might check their website, but I don't remember it being very informative. I know that Interplast only takes BE/BC PRS and support physicians (Peds, Gas).

 

[toofache32]

Max outlined my view in a little more detail. The state systems for crippled children's clinics are more and more integrated clinics making it difficult for people to "dabble" in doing these kinds of cases anymore, encouraging a system where a very few people will do most of these. Alongside this consolidation has been the reduction in reimbursements 75-80%+ for these procedures which is a strong disincentive for everyone. So practical hurdles + low pay = little interest.

In contrast to Max, I've had little interest in these kind of cases during training because I know I will never do one in practice

I agree and I think this sums it up nicely.

 

[bobby6]

I think its funny that Dentists/Oral surgery guys always have to jump into the conversation especially in threads such as these. Plastic surgery is obviously the leader in doing cleft plate/lips because they are the ones who publish and do most of the research concerning this area. Though some ENTs do this sort of thing, they aren't putting the majority of the literature out there on cleft palates and lips. The obvious leaders of what ever field are the ones that are writing the books and doing the research. Look up an craniofacial book, I'm sure the majority of them by far are written by plastic surgeons.

While Oral surgery is a great profession, there will always be competition with MD trained ENTs and Plastic surgeons which will work hard to limit the scope of practice for oral surgeons. Just look with what happened with the oral surgery guys in California who tried to do elective facial plastic surgery.

 

[OzDDS]

I think its funny that Dentists/Oral surgery guys always have to jump into the conversation especially in threads such as these. Plastic surgery is obviously the leader in doing cleft plate/lips because they are the ones who publish and do most of the research concerning this area. Though some ENTs do this sort of thing, they aren't putting the majority of the literature out there on cleft palates and lips. The obvious leaders of what ever field are the ones that are writing the books and doing the research. Look up an craniofacial book, I'm sure the majority of them by far are written by plastic surgeons.

While Oral surgery is a great profession, there will always be competition with MD trained ENTs and Plastic surgeons which will work hard to limit the scope of practice for oral surgeons. Just look with what happened with the oral surgery guys in California who tried to do elective facial plastic surgery.

I also find it interesting that a lot of even the Plastics trained guys find the need to get dental degrees as well as medical degrees (like OMFS) beause they realise the importance of the training to the surgery they are doing. Even Plastic guys who do this, usually do an extra Craniomaxillofacial surgery fellowship after their plastics training.. to which there is a lot of overlap with Oral and Maxillofacial training who are already doing cranial distraction, orthognactic, and which the major focus is working with cranial bone and oral and facial reconstruction. This is definitly in the scope and relm of dentistry. Your fooling yourself if you say otherwise. There are tons of dental guys who do research on clefts. Go look at any of the leading Craniofacial embryology, Craniofacial biology, or Craniofacial/Craniomaxillofacial surgery journals and find out for yourself.