Cleft Lip/Cleft Palate

[LuckyMD2b]

I think that Cleft Lip/palate surgery is really cool, and think that it must be a very gratifying operation to do.

I was just wondering is that one of the most common congenital defects treated by plastics surgeons? Is it a very difficult procedure that is done by specialized docs or can it be done by virtually every residency trained plastic surgeon? and do the guys who do this surgery focus on children and congenital disease or do they do other stuff too? Can it be done by ENT's too?

Thanks for the info

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[maxheadroom]

Cleft lips are probably the most common congenital anomaly seen. All plastic surgeons should be able to manage a cleft lip without any difficulty. A unilateral is certainly fairly simple. A bilateral is certainly more difficult. Most surgeons should be able to do palates, also, but palates require more of a multidisciplinary clinic (orthodontists, speech path). Because of the need for a team, palates tend to be done mostly by craniofacial specialists (just because they tend to have the team available). There are some craniofacial/peds plastics people who do primarily peds and c/f, but most do a fair amount a general/cosmetic plastics. I've heard of some ENTs who do clefts. There's no reason why they couldn't do them (once they have the training). It's mostly a political thing; plastics just tends to do the clefts in most centers.

 

[Leforte]

I agree with Maxheadroom.

From the ENT trail this year, a few places offered cleft training - UC Davis, Minnesota and I think Alabama. Several other places offered 2 week blocks where residents went to 3rd world countries to learn the surgeries.

So I would agree that plastics would be the best route into this if that's what you'd like to do.

I spoke with a ENT/facial plastics guy here who does them very infrequently (Plastics does most of them) and asked him why he doesn't do more, and was told that the Plastics department has the political draw. He also commented that the procedure has very low reimbursement and that most people who do it do so for the kids.

 

[omsres]

My oral and maxillofacial program does a fair amount of cleft palate repair as well. It is a very interesting surgery.

 

[Energon]

At my institution clefts are done mostly by the OMFS team. They work with Orthodontics and Prosthodontics teams as well

 

[USC2003]

Primary closure of cleft lip/palate is usually performed by plastics. OMFS will usually do the bone grafting into the alveolous site of the cleft that is lacking bone. The only oral surgeons I know that do primary closures have further training, like a fellowship in plastics.

 

[DoctorDoom]

Historically the procedure was done by plastics, but I've seen mostly multi-disciplinary these days, with OMFS involved in palate sometimes. Really depends on training too, most ENT's aren't trained in cleft.

 

[aphistis]

At my institution clefts are done mostly by the OMFS team. They work with Orthodontics and Prosthodontics teams as well

Ditto Indiana.

 

[droliver]

Ditto Indiana.

I just finished a case with one of my staff who recently trained @ Indiana & he said there was none of the cleft lip & palate surgeries being done by the dentists/oral surgeons except for some of the latter stage alveolar bone grafting.

 

[River13]

I just finished a case with one of my staff who recently trained @ Indiana & he said there was none of the cleft lip & palate surgeries being done by the dentists/oral surgeons except for some of the latter stage alveolar bone grafting.

Primary closure is taught at only a few OMS residencies, where the staff have typically done craniofacial fellowships after their OMS training. Oregon is one of them. All the OMS residents gain the training there.

 

[Energon]

That is right. I forgot to mention that my insititution is has this one year craniofacial fellowship for OMS people so I guess they are OMFS fellows and not OMS residents