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What is a Cleft Surgeon?

Discussion in 'Medical Students - MD' started by GenericApplicant, Sep 28, 2014.

  1. GenericApplicant


    Jun 2, 2014
    Though its still a long way away since I'm an M1, I am very very interested in working with Operation Smile in the future so I can perform operations on cleft palettes and lips. I noticed that they need Cleft Surgeons according to their website. However, this doesn't seem to be a specialty in surgery. What specialty would you have to be to perform surgeries required by Operation Smile? I was thinking maybe an ENT or Plastic Surgeon, but I'm not sure. Also, would it be possible for a general surgeon to qualify as a Cleft Surgeon? I ask, because if I can't obtain a Plastic Surg or ENT residency, which is most likely, then I was wondering if General Surgeons can still perform these operations.

    Maybe I should direct this at Operation Smile, but I wanted to get input from all you people on SDN. Hopefully, one of you has worked for Operation Smile and can enlighten me.
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  3. VisionaryTics

    VisionaryTics SeƱor Member 7+ Year Member

    Jan 13, 2009
    Most (probably more than 80%) cleft palate operations are done by plastic surgeons, especially those who have done craniofacial fellowships.

    It is unusual for otolaryngologists without fellowship training to do clefts, but there are a few places in the country where one gets significant cleft exposure in residency. Most otolaryngologists who do clefts have done pediatric fellowships at the places that do a lot of clefts (Colorado, Arkansas, Pitt, etc).

    General surgeons without fellowship training in plastic surgery (and craniofacial superfellowship afterwards) do not do clefts.
    Evergrey and Winged Scapula like this.
  4. Screwtape

    Screwtape Dentist 7+ Year Member

    Aug 25, 2008
    Midwest, USA
    Oral and maxillofacial surgeons as well.
  5. mrusiku


    Nov 22, 2013
    There is a MS3 at Harvard somewhere on this board who has also mentioned he wants to work with Operation Smile. Hopefully he sees this thread and can offer what he knows.
  6. Wordead

    Wordead 10+ Year Member

    Dec 21, 2007
    You can do clefts as an otolaryngologist abroad too with some organizations (world pediatrics project comes to mind). As visionarytics said, it's pretty hard to do it in the US if youre not a craniofacial trained plastic surgeon.
  7. IlDestriero

    IlDestriero Ether Man Physician Faculty 10+ Year Member

    Nov 24, 2007
    The ivory tower.
    Plastics or ENT with a facial plastics fellowship. General surgeons don't do cleft lip/palate surgery. Maybe OMFS, though not where I've worked.
  8. member1000765

    member1000765 2+ Year Member

    Mar 3, 2013
    A few things to add to the conversation. There's a lot of politics in cleft lip/palate surgery. While OMFS and ENT work in the oral cavity a heck of a lot more than PRS, for whatever the reason PRS has historically had a stronghold on cleft lip and palate surgery at most programs. I'm not exactly sure why, and multiple PRS cleft surgeons I know of were initially ENT trained, but that's the way it is. That doesn't exclude ENT's and OMFS surgeons from doing clefts abroad; some of my head and neck attendings do beautiful cleft lips/palates and will fix children on their overseas humanitarian trips. But unless you either have PRS/ENT/OMFS training, you won't be qualified to do cleft surgery. Also, while Operation Smile is great and does a lot of cleft work, there are lots and lots of opportunities to go abroad and fix clefts with organizations other than a major headline grabbing organization like Operation Smile.

    Cleft lip/palate surgery was one of the things that initially drew me into a surgical career. While my career focus has changed, it still is very rewarding surgery.
    Winged Scapula likes this.
  9. bc65

    bc65 2+ Year Member

    Oct 16, 2013
    A few points to consider regarding your desire to participate in overseas cleft surgery:

    Perhaps twenty years ago, any plastic surgeon would be welcomed to perform cleft surgery, because cleft surgery was considered one of the basic operations of the specialty. However, in recent years, those plastic surgeons with craniofacial fellowships have mostly succeeded in limiting cleft surgery to those with a craniofacial or cleft or pediatric plastic surgery fellowship. So, it's most likely that you would not only need to do a plastic surgery residency to do cleft surgery abroad, but a craniofacial fellowship as well. Even then, you might not be able to find an opportunity to do surgery abroad, since there are generally more surgeons willing to go overseas than there are places on trips. In fact, the politics in many of these organizations is quite fierce. That's why these organizations proliferate. The senior people in each organization keep a tight reign on who gets to go on trips, and on which trips. If you're not part of the inner circle, one of their associates, or from their university, you won't be selected. So, frustrated plastic surgeons then start their own organizations. There are also groups that center around other medical specialties, such as ophthalmology. Many other trips treat general surgery problems. There is a group of OR nurses in my hospital who organize an annual trip to the Phillipines every year, and the physicians on that trip treat a wide variety of surgical problems. Of course, if you follow the news, you know that there is a need for primary care and infectious disease specialists overseas as well.

    While plastic surgeons do almost all of the cleft lip surgery, many other procedures are done on a variety of trips with various organizations.
    Even on a trip devoted to cleft lip surgery, there are opportunities for non-plastic surgeons to participate. In fact, surgeons will make up a small minority of the participants. You could participate as a pediatrician, an anesthesiologist, a nurse, a scrub tech, as a lay person providing administrative support, or as a translator. As a physician, you would generally have to pay for your own airfare and expenses. If you are serving in a non-physician role, more of your expenses might be covered.

    As an aside, be aware that in many countries that these organizations visit, there are local plastic surgeons capable of doing the surgery. What is lacking is not so much the doctors, as the money. In many third-world countries, not only is the patient responsible for paying the doctor and the hospital, but they have to buy their own medical supplies: IV tubing, syringes, saline, antibiotics, etc. So it's the poor people that are treated by these organizations. The wealthy and the middle class can be teated by the local doctors. For example, some of these organizations have trips to Vietnam. I have been to Vietnam, and had occassion to visit one of the hospitals there. It was on par with most of the hospitals I have worked in in the US. It was staffed entirely by physicians who rotated out from France. They had CT scanners, MRI scanners, private rooms, and very attentive nursing staff. But, it was very expensive. It catered to the very wealthy. or those who had relatives abroad who could pay the bills. It's like when you read about famine that kills thousands of people. It's not that there isn't any food around. There's usually a lot of food, otherwise, the journalists who report the story would starve to death. Rather, food has become too expensive for the poor, who barely get by under normal conditions, are priced out of the market, or can only afford half of what they would usually eat. So, if you do go abroad on these trips, be aware that in many of the countries you go to, you will not be providing services that are unavailable in that country, although they will be otherwise unaffordable to your patients. That said, there are some countries where specialists really don't exist. In those instances, there are opportunities to not only perform surgery, but also to teach new techniques to local doctors. But you don't have to be a plastic surgeon to be of use overseas.
    Winged Scapula likes this.

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