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Plastic and Reconstructive Surgery News

Winter 2000, Volume 25, Number 1
from the American Cleft Palate-Craniofacial Association Newsletter

By Donald V. Huebener, DDS, MS

BANGKOK--The first ACPA Ambassador Team, including Drs. Jeffrey Marsh, Donald Huebener, and Linda D'Antonio, returned to Bangkok at the request of Dr. Wiratt and the Cleft Team at the Queen Sirikit Institute of Child Health to continue their work and assist in their sister team's organizational efforts.


Surgery for cleft lip/palate and other craniofacial anomalies continues to improve in quality and scope. Dr. Wiratt was primarily interested in surgical management of velopharyngeal dysfunction, now that velopharyngeal diagnostics have been available for one year. Dr. Marsh performed sphincter pharyngoplasties and reviewed pharyngeal flaps with him. Second stage microtia reconstruction was done for the child operated upon during the 1998 Ambassador Team visit, and two first stage microtias were performed. The problem of postpalatoplasty infection and fistula formation was discussed with a plan for a review of palatoplasty techniques in 2000. Dr. Wiratt was able to have many of the patients operated upon in 1998 return to the hospital for follow-up with Dr. Marsh. Initial plans for establishment of a computerized cleft registry at Queen Sirikit Institute were discussed.

Dentistry is evolving to a more mature cleft consultative and treatment network. All cleft patients now are referred to the Department of Dentistry where cleft infants are examined prior to surgery and dental models are taken. Post-cheiloplasty infants are followed both by Plastic Surgery and Dentistry and now are evaluated on a routine basis.

Regular dental care is performed by the Department of Dentistry when logistically feasible, and cleft patients are placed into an oral health care program to assist in reducing the number of carious lesions.

Prevention is monitored on a routine basis with an active recall system in place. "The Bangkok Team is moving in the right direction with emphasis in promoting good oral health," Huebener noted. "It's exciting that we're able to make a positive impact."

In Thailand, Speech Language Pathology (SLP) is a relatively new profession. "There is one training program in the country (the only one in Southeast Asia)," said D'Antonio. Virtually all SLPs are hospital based, and there is usually only one SLP at any given hospital. Opportunities for continued education or specialty training are very limited.

During last yea's visit to the Institute of Child Health, the primary emphasis of speech pathology was training regarding evaluation and management of velopharyngeal function. There was a heavy emphasis on collaboration between speech pathology and surgery. At that time, two additional needs were identified and addressed during this follow-up visit. First, a two-day continuing education course on evaluation and treatment of speech disorders associated with clefting was given at the national training program. Approximately 60 SLPs from around the country attended. The faculty and attendees identified topics for future courses.

Work at the Institute of Child Health continued to stress increased interaction and collaboration among specialists. During last year's visit, the ENT department identified the need for further training for fitting hearing aids, especially in children with craniofacial anomalies. In response to this request, an audiologist from Loma Linda University, Susan Grossfield, participated on this year's team, emphasizing on hearing aid fitting. With the assistance of Maureen Riski, many hearing aids were obtained from a variety of donors. These hearing aids were then distributed and many of them fit during this visit. Plans for next year's follow-up trip are underway and include a proposal for a week-long course at the national training center.

"We were delighted to accept a return visit to Bangkok's Children's Hospital and to discover the tremendous progress made since our last visit in November 1998," said Marsh. "It is satisfying to know that our efforts in promoting team care and multidisciplinary interaction are having a positive result. All of us will continue to assist the Bangkok group in any way we can."


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