WEBVTT
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Today, we're joined by Dr. Richard Thompson, Pediatric Plastic Surgeon at UT Health San Antonio.
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Immediately after, he completed left lip and palate surgery on a baby here at University Hospital.
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We did a debrief. So as a team, where we just like discuss everything that went
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well, everything that went better, just reflect on, you know,
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in the case and could do some safety checks.
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Dr. Thompson, it must be so fulfilling.
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After doing a surgery like this, it changes a baby's life for the better.
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Yeah, 100%. I mean, it's life-changing surgery.
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Very common. So one in 700 babies who are born will have a cleft lip or palate.
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It's such an honor to be here and to give us an inside peek.
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A lot of our listeners, they refer a patient for cleft palate surgery, plastic surgery.
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But here you can walk us through a bit what happens actually.
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For example, just now in this surgery on this baby, can you walk us through?
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Yeah, of course. So babies can be born with either a cleft lip,
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a cleft lip and a cleft palate, or just nice a cleft palate.
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This baby we just operated on was born with a bilateral cleft lip. So that means that.
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The middle part of the lip is not connected to the parts of the lip at the side.
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And that goes all the way through to the roof of the mouth as a cleft palate.
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So it's a staged operation so we do the cleft lip operation first and around three months of age
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and in some cases for a bilateral cleft if it's a particularly wide cleft lip
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we may do an intermittent stage where we get the muscles halfway across but
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not quite meeting it's called a lip adhesion and then come back,
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three months later and do the completion so that's what happens this baby.
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Usually three months after the lip surgery, I try and repair the palate.
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So I try and repair the palate quite early, about six months of age,
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which some people may think, whoa, that's so early to do a palate repair.
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But actually what we're aiming to do is try and get everything repaired before
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the baby starts speaking.
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So we know from evidence in the literature and big kind of nationwide kind of
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cohort studies and things like that, we know that,
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Today, we're joined by Dr. Richard Thompson, Pediatric Plastic Surgeon at UT Health San Antonio.
00:00:08.532 --> 00:00:14.564
Immediately after, he completed left lip and palate surgery on a baby here at University Hospital.
00:00:15.977 --> 00:00:21.367
We did a debrief. So as a team, where we just like discuss everything that went
00:00:21.367 --> 00:00:25.367
well, everything that went better, just reflect on, you know,
00:00:25.367 --> 00:00:28.099
in the case and could do some safety checks.
00:00:28.461 --> 00:00:30.928
Dr. Thompson, it must be so fulfilling.
00:00:31.415 --> 00:00:35.595
After doing a surgery like this, it changes a baby's life for the better.
00:00:35.734 --> 00:00:38.184
Yeah, 100%. I mean, it's life-changing surgery.
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Very common. So one in 700 babies who are born will have a cleft lip or palate.
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It's such an honor to be here and to give us an inside peek.
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A lot of our listeners, they refer a patient for cleft palate surgery, plastic surgery.
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But here you can walk us through a bit what happens actually.
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For example, just now in this surgery on this baby, can you walk us through?
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Yeah, of course. So babies can be born with either a cleft lip,
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a cleft lip and a cleft palate, or just nice a cleft palate.
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This baby we just operated on was born with a bilateral cleft lip. So that means that.
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The middle part of the lip is not connected to the parts of the lip at the side.
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And that goes all the way through to the roof of the mouth as a cleft palate.
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So it's a staged operation so we do the cleft lip operation first and around three months of age
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and in some cases for a bilateral cleft if it's a particularly wide cleft lip
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we may do an intermittent stage where we get the muscles halfway across but
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not quite meeting it's called a lip adhesion and then come back,
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three months later and do the completion so that's what happens this baby.
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Usually three months after the lip surgery, I try and repair the palate.
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So I try and repair the palate quite early, about six months of age,
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which some people may think, whoa, that's so early to do a palate repair.
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But actually what we're aiming to do is try and get everything repaired before
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the baby starts speaking.
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So we know from evidence in the literature and big kind of nationwide kind of
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cohort studies and things like that, we know that,
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if we can repair the palate before the baby starts speaking,
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that's better in the long term for speech and maybe less need for speech therapy.
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So the palate is very important for speech.
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Sounds like Bs and Ts and Ds all need you to generate pressure within your mouth,
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in order to say those sounds.
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And if you have a cleft palate, the air, instead of the pressure coming out
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of the mouth, the air can escape through the nose.
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And that can make understanding somebody's speech really, really difficult.
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So the idea is to put the palate together and crucially the muscles of the palate
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which lift the soft palate up and down to allow the throat to close to the mouth
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and allow allow that pressure to generate,
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so the idea hopefully after we've repaired this palate is everything heals and
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the baby does well initially feeding,
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you know straight away afterwards and recovering well and then afterwards,
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you know, really allowing him to develop his own speech and then if there's
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any concerns at all, just getting into speech therapy very early. So what.
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With regards to sending to plastic surgery, referring to plastic surgery,
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what advice do you have for our pediatrician listeners? Yeah,
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so the biggest advice I could give is cleft care is done as part of a multidisciplinary team.
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So there's lots of different factors within cleft care, and the surgeons are just one part.
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So the cleft lip and palate taking is the best manager in a multidisciplinary
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team, which we do have here at University Hospital. We've got the full,
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comprehensive cleft care.
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So the surgeons, we've got speech therapy, orthodontists, cleft coordinator,
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cleft nurses, and we've got pediatricians, ENT doctors, oral,
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maxillary, facial surgeons.
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And all of those members of the team will play a very important role at different
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stages of the baby's journey.
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Is the first step as early as possible? send the baby, though,
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to see plastic surgery for a consult?
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Yeah. So I think initially when the, so I guess there's two ways in which a,
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baby's diagnosed with a treflip and or pallet.
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The first would be antinatally. So it's detected on the scan in the, you know, 20-week scan.
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And that means that quite often I'm seeing parents or parents-to-be.
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Before the baby's born so we can go through what to expect and and the main
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emphasis on that is just meeting the parents kind of letting them know that
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there's a full team to support them
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and then initially trying to focus on feeding and ensuring that the baby is
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as well putting on weight nicely and so initially there's you know i try and
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avoid kind of any surgical surgical chat
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initially and just focus on you know just the wonder of having a baby for one
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and then secondly just you know emphasizing the feeding which is the most important
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thing initially for a pallet.
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There's also, you know, psychological support because, you know,
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it can be sometimes a bit of an unexpected diagnosis.
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So, you know, having supporting families with that is also important.
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And that's, you know, part of our role in the multidisciplinary team.
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Cleft lips are more easily identifiable on scans rather than the cleft palate.
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Unless the baby's opening their mouth, just it can be quite difficult to get that view, I think.
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So quite often, if it's a high-stage palate, it can sometimes be diagnosed afterwards.
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And sometimes, you know, for whatever reason, there hasn't been any imaging
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before and it's identified after birth.
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So both ways. Initially, we'll be contacted all pediatricians on the NICU.
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We'll contact the craniofacial team and one of us will come along and just introduce
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ourselves to the mother and just really support. The speech therapist will support
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them in their feeding initially.
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And then usually arrange a follow-up appointment with one of the surgeons in
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about six or eight weeks after birth.
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Richard, let's talk about timing. How do you determine the ideal timing for
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cleft lift and palate repair after the baby is born? Can you tell us a little
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bit more about that? Yeah.
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So this is, again, there's no right answer for this.
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There's lots of different protocols out there so which probably tells you that there's no.
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One right way but my personal view is to repair the cleft lip at about three months of age,
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because that's a stage at which you know that the baby's nice and healthy putting
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on weight doing well from a feeding perspective
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and they're a little bit more resilient than they are when they're first born
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and they're ever so slightly bigger, just makes it technically a little bit more feasible to get,
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good repair of the muscle and make sure that the nose is hopefully nice and lined up.
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So three months for a lip and then the palate, my personal view,
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and at the same time as the lip, I actually repair the very front part of the
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palate, which is called a vomer flap.
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And that's kind of almost in continuity with the floor of the nose.
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So it's kind of a nice kind of continuous closure, the kind of front of the
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mouth and then the floor of the nose, which is part of a cleft lip repair.
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And that means that over time I come to the palate repair three months later,
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that means that hopefully the floor of the, the front of the pallet's already healed.
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So it makes the second operation a little bit easier.
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How many operations typically happen? So there's primary surgery.
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So that's cleft, for a baby who has a cleft lip and pallet. So cleft lip repair,
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about three months. Cleft pallet, I was gonna say that I tend to do it three
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months. I think we talked about the importance of speech and doing it before speech.
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I think the evidence says that as long as you repair it within the first 12
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to 13 months, then that's kind of a good time really to repair your palate.
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And it gives us a lot of leeway, you know, because, you know,
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I would have to postpone surgery if a child had a cough or a cold or if they had a temperature.
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And that means that if I go through six months, it's the earliest opportunity.
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And if I need to postpone it, you know, there's still a lot of time to repair
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the palate without amount affecting speech.
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So for pediatric clinicians, why is repairing a cleft palate about so much more
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than closing and opening in the roof of the mouth?
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Can you tell me a little bit more about speech? Yeah, I mean,
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this is the most human thing, isn't it? It's just to interact with the world,
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you've got to be able to speak with your peers, your family.
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And without repairing the cleft palate, it makes speech very difficult to understand.
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And that automatically can really reduce some of these opportunities for education
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for relationships for for the whole of life you know even just
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picking up the phone ordering a pizza like you need to be able to be understood
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right so the the palette is you know actually.
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You know i hate to say i don't want to compare one to the other but the palette is so important because
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this is how you get speech and if the palette if the palette isn't functioning
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properly you know that can have lifelong implications which is why it's so important to get the
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primary repairs hopefully done as in a,
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proper team proper multidisciplinary team where you have the expertise of the
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speech therapists the expertise of the ent surgeons the audiologists and you
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know having a whole team to look after that because if,
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when you're born with a cleft palate,
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the tubes in the ear that equalize the pressure when you go up in a plane and
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your ears pop, that's the eustachian tube.
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And that doesn't work quite as well in somebody who's got a cleft palate because
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the muscles are slightly inserted into a slightly different orientation.
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So that means that you can have a buildup of the fluid behind the ear,
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something called glue ear, and that can need,
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either drainage through a little tube that goes in, tympanostomy tube,
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or hearing aids, which can also, you know, obviously increase the sound rather than,
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put the tube in.
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My youngest daughter had ear tube surgery twice and it helped a lot.
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ENT surgeries often do it kind of prophylactically at the time of palate surgery,
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just before the palate surgery usually, just in the same anaesthetic.
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And that allows, hopefully, the hearing to develop atypically.
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The one thing I will say is, you know, the children do have ongoing audiology,
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you know, for the first five years or so. Every six months, I think, the ENT doctors do that.
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So that's important because that obviously, if you can't hear what's being said,
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then that also has an implication for your speech.
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So getting all of those things, you know, sorted is important.
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And insurance companies, though, it sometimes could be considered cosmetic.
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I'd argue that it's definitely not a cosmetic procedure. Yeah,
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I'd say this is reconstructive surgery.
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This is restoring the form and function of something which is congenitally acquired.
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So this is a congenital surgery.
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Is it sometimes denied though and not covered by insurance?
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I think primary surgery is always pretty much covered.
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I think sometimes some patients have run into problems with some of the secondary
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surgeries that may come much, much later down the line if they.
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Desire to have a lip revision or a nose that they would like to be maybe a little
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bit more symmetrical or their breathing is sometimes affected,
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you know, the nasal breathing.
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So those can occasionally be denied by insurance companies.
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But, you know, that's usually not the case when you see somebody in a proper
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cleft MDT we can usually get those cases funded. I mean, there's no reason that
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they shouldn't be funded. Yeah.
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And for families without insurance, there's an amazing program called Fresh
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Start. Yes, yes. So Fresh Start is a brilliant organization,
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essentially fills a gap between people who,
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can and can't have insurance so things that may be deemed not covered by insurance
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fresh start can step in and do that funding for things that are deemed cosmetic as you said,
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in my opinion are technically not cosmetic but they we can we can cover those
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in fresh start yeah that's amazing and i know you volunteer your time and some
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other surgeons do here on the weekends when there's an,
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operating room that's available and the program covers travel for families.
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It just sounds incredible. It does. And I think it's a real safety net actually
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for children in Texas and also children internationally. You know,
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there's children who are covered internationally.
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There's programs in Costa Rica, in Mexico that work with Fresh Start.
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And are you still traveling to do clubhouse? I do, yeah. So I work with Austin
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Smiles, which is a brilliant tech charity.
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They also have some domestic role as well.
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They cover, they have support groups, which are very good. And they have early
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born, early starter packs with extra bottles and, you know, some kind of advice
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and information leaflets, things like that, which is excellent.
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But yes, they also, we also support local services. So with Austin Smiles,
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they work with the same teams over and over again. So it's not a fly in,
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fly out organization. It's very much kind of supporting local services.
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There's local orthodontists, for example, local speech therapists,
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and we support when asked, support their services. Yeah. That's awesome.
00:14:31.589 --> 00:14:35.804
Richard, how has cleft palate surgery evolved over the past decade and what
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techniques or technologies have most improved outcomes?
00:14:39.530 --> 00:14:46.616
So I'd say one of the most important factors would be collection of data actually.
00:14:46.837 --> 00:14:50.874
So this is looking at big longitudinal studies and that's, you,
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know, by collecting long-term data, there's some countries that have databases
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where every single child who's born with a cleft is actually followed up and
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that is kind of kept on going
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for their whole for their whole life up until 20 21 um so you get an opportunity
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to look at what what operations and what,
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therapies are most effective because quite often parents will ask me you know what's caused the cleft.
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Often it's a complete interplay between genetic causes so some clefts run in
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families, so genetic factors and also environmental factors.
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And we don't always know what those are, but we know that some things can predispose to cleft.
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So some medicines for epilepsy, anti-convulsant medications,
00:15:42.133 --> 00:15:46.272
and for some lifestyle factors that can also predispose to cleft.
00:15:46.713 --> 00:15:53.555
But often it's an isolated anomaly that there's no, we can't find a cause.
00:15:54.101 --> 00:15:58.524
Certain medications could cause it? So medications, it's mainly the anti-epileptic
00:15:58.524 --> 00:16:02.134
medications that are, phenytoin is classic.
00:16:02.514 --> 00:16:07.438
Also, there are lots of, there are lots of medications that interact, can interact.
00:16:07.734 --> 00:16:12.104
You know, it's too long to list. Yes. What does the journey look like from infancy
00:16:12.104 --> 00:16:16.413
through adolescence? What additional procedures or therapies might some children need?
00:16:16.674 --> 00:16:21.579
So I always think of it in terms of kind of getting onto a school bus, I guess.
00:16:21.934 --> 00:16:25.927
So there's lots of people on the bus and.
00:16:26.574 --> 00:16:29.848
That includes the patient, the baby, and their family.
00:16:30.406 --> 00:16:34.427
And the driver of the bus will change according to the age.
00:16:34.880 --> 00:16:38.727
So to start with, you'll have the speech therapist driving the bus,
00:16:39.104 --> 00:16:45.205
and they'll be doing the feeding and making sure they're putting on weight and all those things.
00:16:45.605 --> 00:16:49.361
And then the surgeon takes over and does the cleft lip and the cleft palate.
00:16:49.660 --> 00:16:53.059
And then they swap over, and then it's the speech therapist.
00:16:53.059 --> 00:16:57.561
So when they start speaking, they will be seeing speech pathologists.
00:16:57.956 --> 00:17:04.179
And then after they kind of get to an age around seven, they'll want to be looking
00:17:04.179 --> 00:17:09.129
at their dentition and doing x-rays to see how their teeth are forming,
00:17:09.129 --> 00:17:10.186
the adult teeth are forming.
00:17:10.789 --> 00:17:14.342
Because often if they've got a cleft in the alveolus in the gum,
00:17:14.942 --> 00:17:17.984
they'll need to have a bone graft put in.
00:17:18.355 --> 00:17:20.474
And that's usually between seven and 10 years old.
00:17:20.962 --> 00:17:24.494
And that's when the orthodontist starts driving the bus and also the surgeon.
00:17:24.802 --> 00:17:29.684
So we take bone from the hip usually and put that into the gap.
00:17:29.980 --> 00:17:34.988
So that can allow the adult teeth, usually the canine teeth,
00:17:35.319 --> 00:17:40.723
to come down and erupt into bone as opposed to just interrupting into thin air.
00:17:41.409 --> 00:17:44.897
And that will also allow, once that's set and it's got a tooth in there.
00:17:45.634 --> 00:17:50.875
That will allow the orthodontist to start moving teeth in order to try and make
00:17:51.113 --> 00:17:55.717
with teeth a bit straighter than they may be in somebody who was born with a
00:17:55.717 --> 00:17:57.144
cleft, lip, and or palate.
00:17:57.454 --> 00:18:02.386
So then after that, they go away. They're in the orthodontic chair for quite a while.
00:18:02.793 --> 00:18:07.967
And then they'll go out. They may see speech therapy still. And then they're
00:18:07.967 --> 00:18:09.174
moving into adulthood, really.
00:18:09.771 --> 00:18:14.299
And then once they're getting up to skeletal maturity, so 17, 18.
00:18:15.107 --> 00:18:21.167
If they need surgery on their jaw, occasionally some children who have a cleft
00:18:21.167 --> 00:18:23.407
lip or palate and or palate will have,
00:18:23.867 --> 00:18:27.641
maybe a slight growth restriction in the middle part of their face,
00:18:28.013 --> 00:18:32.738
which means that their teeth don't always meet in the correct occlusion.
00:18:33.284 --> 00:18:37.557
And occasionally that does need surgery to correct. So that's called orthognathic
00:18:37.557 --> 00:18:39.901
surgery and that's moving the jaws either forward or back.
00:18:40.508 --> 00:18:45.512
And that would be usually around 17, 18, 16, 17, 18 years of age.
00:18:45.959 --> 00:18:51.132
So that's, these kind of surgeries when you get later, they're very much kind of the.
00:18:51.882 --> 00:18:55.720
Child's choice, young adult's choice, whereas the primary surgeries,
00:18:56.074 --> 00:18:58.213
the parents will be making those choices for them.
00:18:58.515 --> 00:19:02.944
And I kind of strongly recommend all of those primary surgeries.
00:19:03.345 --> 00:19:09.234
And then the surgeries when you get a little bit older, tend to be up to the
00:19:09.234 --> 00:19:11.939
young adult, kind of older child, young adult.
00:19:12.444 --> 00:19:16.984
So yeah, then after the orthognathic surgery, if they want,
00:19:17.544 --> 00:19:23.174
a nose maybe that's slightly more symmetrical again you know i tend to not put
00:19:23.174 --> 00:19:27.664
any any kind of pressure on on the child to make that decision because that
00:19:27.664 --> 00:19:31.434
is a very personal choice and if they you know i'll usually,
00:19:31.956 --> 00:19:36.844
say what is available and what you know could could be you know done if,
00:19:37.584 --> 00:19:43.423
if if it was something that they were interested in and that would be a septorhinoplasty
00:19:43.748 --> 00:19:48.514
and that would be moving the nose into a straighter position and usually trying
00:19:48.514 --> 00:19:50.451
to match the two sides of the nose,
00:19:51.025 --> 00:19:55.438
and then after that maybe a lip revision if again,
00:19:56.204 --> 00:19:59.629
if that was something that they were interested in having done.
00:20:00.424 --> 00:20:07.214
Richard what's one misconception you wish every pediatric provider understood
00:20:07.214 --> 00:20:08.967
about cleft lip and palate?
00:20:10.343 --> 00:20:17.832
I'd love people to think of cleft lip and palate as more than a cleft lip repair because.
00:20:19.824 --> 00:20:24.124
A lot of people will be aware of cleft lip surgery, but not so many people will
00:20:24.124 --> 00:20:30.704
be aware of cleft palate surgery and the implications on speech and the implications
00:20:30.704 --> 00:20:32.082
that it may have on hearing.
00:20:32.453 --> 00:20:37.744
So I think that's one of the things that I'm very keen to promote.
00:20:38.409 --> 00:20:46.430
And also the fact that we know from big longitudinal studies that a proportion of children who have,
00:20:47.463 --> 00:20:51.792
their palate will need further surgery for their speech. And we know that,
00:20:51.792 --> 00:20:56.555
you know, even in the best hands, in the best centers anywhere in the world,
00:20:56.805 --> 00:20:59.696
we still know that a proportion of those children,
00:21:00.201 --> 00:21:02.587
do need more surgery for their speech.
00:21:02.923 --> 00:21:08.892
And if we know that, we should detect it really early to try and address anything
00:21:08.892 --> 00:21:10.641
before a child starts school.
00:21:11.135 --> 00:21:16.442
That's the priority. So I'm very keen on if there's any detection of some air
00:21:16.442 --> 00:21:20.912
escaping through the nose, getting them in with the speech pathologist for an
00:21:20.912 --> 00:21:24.219
evaluation, and then they'll be able to expertly say,
00:21:25.182 --> 00:21:27.081
this air escape is due to.
00:21:28.271 --> 00:21:33.351
Venopharyngeal insufficiency, which means the palate isn't quite reaching the back of the throat.
00:21:33.757 --> 00:21:39.302
And if that's the case, we can get the child in, have a look at an x-ray or
00:21:39.702 --> 00:21:43.392
camera through the nose and just see how the palate's moving and see if there's a gap.
00:21:43.764 --> 00:21:49.383
And the idea would be to try and address that before the child starts education
00:21:49.621 --> 00:21:51.772
because we can correct that with surgery.
00:21:51.772 --> 00:21:56.462
Well, in fact, you can't correct that with speech therapy if it's aeroscape
00:21:56.462 --> 00:22:00.052
through the nose because of bilopharyngeal insufficiency.
00:22:00.418 --> 00:22:04.017
We can do things like lengthen the palate, which would be the first line.
00:22:04.959 --> 00:22:10.712
And if that's not effective, we can shorten the back of the throat for a pharyngoplasty. Amazing.
00:22:11.124 --> 00:22:14.940
So in the well-child visits for the pediatrician, do you have any advice on
00:22:14.940 --> 00:22:18.119
how do you tell that that could be happening? Oh, 100%.
00:22:18.578 --> 00:22:23.470
If the school teacher or the pediatrician has concerns with speech and the child
00:22:23.470 --> 00:22:29.890
has a history of a cleft palate, then definitely re-refer back to the clefts,
00:22:30.029 --> 00:22:32.265
craniofacial multidimitim. team.
00:22:32.572 --> 00:22:35.575
And we will see the child, they'll have a speech assessment,
00:22:35.906 --> 00:22:39.320
speech evaluation, and we'll see if there's something that can be corrected
00:22:39.320 --> 00:22:41.073
either with more therapy,
00:22:41.520 --> 00:22:46.880
tailored to specific, you know, speech sounds, or if they would benefit from
00:22:46.880 --> 00:22:50.794
surgery, which may be lengthening the palate, maybe re-repairing the palate.
00:22:51.165 --> 00:22:55.661
It may be repairing a hole. Sometimes there's a little hole that can form. It's called a fistula.
00:22:56.353 --> 00:23:00.710
It's maybe a case of repairing that or a pharyngoplasty. So there's lots of
00:23:00.710 --> 00:23:07.190
options. And a lot of that will depend on how short the palate may be or what
00:23:07.190 --> 00:23:09.467
the movement of the palate looks like.
00:23:10.214 --> 00:23:14.990
So after finishing today's surgery, what gives you the greatest sense of purpose
00:23:14.990 --> 00:23:19.720
in caring for these children and families and that baby? Yeah.
00:23:20.445 --> 00:23:28.200
I mean, when a cleft lip has just been repaired, it's a big transition, actually.
00:23:28.640 --> 00:23:34.860
And sometimes that can be very overwhelming, actually, for the parents.
00:23:35.240 --> 00:23:40.769
They're used to their beautiful baby and the appearance of the baby's changed.
00:23:41.172 --> 00:23:44.800
So that's always quite an emotional time, I think.
00:23:44.800 --> 00:23:50.300
When you've first done the surgery and you go to recovery and then go and speak
00:23:50.300 --> 00:23:54.220
to the parents and bring the parents back to see their baby again,
00:23:54.220 --> 00:23:56.854
and that can be quite an emotional time.
00:23:57.815 --> 00:24:02.429
And, you know, that's obviously, you know, I hope that that's,
00:24:02.806 --> 00:24:07.460
that they're happy with the results, but it is even, even though it may look
00:24:07.460 --> 00:24:10.425
more typical for, for a child without a cleft lip,
00:24:10.848 --> 00:24:12.828
you know, it's still a big change because,
00:24:13.680 --> 00:24:19.116
babies who got a cleft lip have got this huge, beautiful smile, really broad.
00:24:19.574 --> 00:24:20.880
And I was thinking, oh, I'm kind
00:24:20.880 --> 00:24:24.176
of, it's a shame that I have to make the smile a little bit less broad.
00:24:24.449 --> 00:24:28.450
The baby will be hospitalized for how long? Yeah. So I usually,
00:24:28.450 --> 00:24:32.799
for actually both cleft lip and cleft palate, I usually keep the babies overnight.
00:24:33.240 --> 00:24:37.518
And that's just checking that they're feeding well, checking their pain's well-controlled
00:24:37.843 --> 00:24:41.118
and also, you know, checking that there's no complications from surgery.
00:24:41.466 --> 00:24:46.210
So that's, you know, any concern with bleeding or any obstruction of the airway.
00:24:46.210 --> 00:24:49.910
And these are things which are very rare in, you know, in surgery,
00:24:49.910 --> 00:24:53.907
thankfully, but can be very serious. And, you know, we just need to monitor that.
00:24:54.406 --> 00:24:59.830
So appreciative to get kind of an inside peek into what happens here in the
00:24:59.830 --> 00:25:01.840
OR and at University Hospital.
00:25:02.187 --> 00:25:06.458
You know, I feel the responsibility, I really do, you know, especially when
00:25:06.836 --> 00:25:11.470
I meet the parents, you know, sometimes before I sit in a clinic and then,
00:25:11.470 --> 00:25:14.312
you know, they're handing over their three-month baby for me to.
00:25:14.970 --> 00:25:17.600
You know, do surgery on the lip and their nose.
00:25:17.600 --> 00:25:24.110
You know, it's a real privilege to do that surgery, but also a huge responsibility
00:25:24.110 --> 00:25:25.531
that I take very seriously.
00:25:26.036 --> 00:25:30.222
And that's also why, you know, people who are doing cleft lip and palate surgery,
00:25:30.704 --> 00:25:35.086
you know, I did three fellowships in order to be able to do this. And that's because...
00:25:35.694 --> 00:25:38.921
You know, this is something which has lifelong implications.
00:25:38.921 --> 00:25:43.871
And, you know, any team, you'd hope that the people who are doing the surgery
00:25:43.871 --> 00:25:49.481
are fellowship trained and they've, you know, got formal residency training and,
00:25:49.963 --> 00:25:53.063
you know, they're certified to be doing the cases.
00:25:53.586 --> 00:25:57.516
And they're working as part of a team. That's the most important thing.
00:25:57.974 --> 00:26:00.331
But, yeah, I feel that responsibility. And that's, you know,
00:26:00.331 --> 00:26:04.761
that's why, you know, I've done three years extra in training to do it.
00:26:05.361 --> 00:26:10.536
And that's why I, you know, try and maintain a practice where I'm doing this regularly.
00:26:10.896 --> 00:26:16.091
You know, I'm doing this regularly. So for me, it is.
00:26:16.821 --> 00:26:20.081
I don't want to say no cases of routine, and certainly cleft lip and palliative
00:26:20.081 --> 00:26:24.851
is never routine, but it's something that I do as part of my normal work,
00:26:25.367 --> 00:26:26.679
as part of my normal practice. Yes.
00:26:26.788 --> 00:26:33.681
And you see patients in clinic at UH and then sometimes at the mark if Medical
00:26:33.681 --> 00:26:37.709
Arts and Research Center for UT Health, so the patient doesn't have to wait to have surgery.
00:26:37.965 --> 00:26:43.461
Yeah, that's right. So I'll see patients initially maybe in the pediatric plastic
00:26:43.461 --> 00:26:48.281
surgery clinic or the cleft craniofacial clinic because certainly all of the
00:26:48.281 --> 00:26:52.070
patients after the initial surgeries will be followed up in the cleft craniofacial clinic
00:26:52.453 --> 00:26:55.121
where we've got all of the team right there in clinic.
00:26:55.121 --> 00:26:58.831
So we don't have to go to all these different appointments. They can go to one
00:26:58.831 --> 00:27:00.673
place and see the whole team.
00:27:01.149 --> 00:27:04.681
And everybody in that clinic is focused on cleft lip and palate.
00:27:04.681 --> 00:27:09.401
They've got a lot of expertise and they've got a lot of additional training
00:27:09.401 --> 00:27:10.750
to be able to do those roles.
00:27:11.097 --> 00:27:16.054
So it's a really good team here at university. And now we're hoping to grow the service even more.
00:27:16.571 --> 00:27:22.241
We hope it's a growing population in South Texas. And there's a lot of children,
00:27:22.241 --> 00:27:28.311
I'm sure, out there who may be struggling with speech and they're not in the system.
00:27:28.311 --> 00:27:31.815
And maybe we can get them back in the system and see if we can help them.
00:27:32.408 --> 00:27:37.659
Yeah. Is there a time when it's too late? No, I don't think it's ever too late because.
00:27:39.641 --> 00:27:44.291
What happens is if you've had a delayed repair, for example,
00:27:44.291 --> 00:27:52.177
or you've had your cleft repair done many, many years ago, it may take more therapy after surgery.
00:27:52.761 --> 00:27:59.481
That's the main thing. So if you've learned to speak with a difference in your palate and you've,
00:28:00.161 --> 00:28:05.461
compensated for the way that the palate works and maybe you use different parts
00:28:05.461 --> 00:28:09.403
of your mouth to form the sounds you can use your throat to form the sounds
00:28:09.844 --> 00:28:13.640
and all that needs to be unlearned if you've got a new repair,
00:28:14.406 --> 00:28:18.795
do you want to quickly say some of the other plastic surgeries that you do yeah oh so,
00:28:19.368 --> 00:28:24.651
i do mainly pediatrics but also a bit of adult surgery as well so the pediatric
00:28:24.651 --> 00:28:28.051
side of things some congenital hand surgery so these are children who are born
00:28:28.051 --> 00:28:31.773
with differences in their hand extra digits digits that fused together,
00:28:32.741 --> 00:28:37.571
ear differences so children who've got different shapes it shaped to their ears there's,
00:28:38.343 --> 00:28:43.981
lots of other kind of maybe slightly more kind of left field things that you
00:28:43.981 --> 00:28:49.408
see in pediatric plastic surgery maybe different shaped heads or different you know,
00:28:49.942 --> 00:28:56.221
congenital lesions so a little you know large pigmented nevus or a scar that's
00:28:56.221 --> 00:28:58.934
happened maybe after burns after trauma it's.
00:29:00.221 --> 00:29:05.001
Even small things small little lesions that are growing little dermoid cysts
00:29:05.001 --> 00:29:07.315
and things like that as well yeah,
00:29:08.164 --> 00:29:13.496
I like to promote having a life outside of medicine. I know you recently joined us from England.
00:29:13.496 --> 00:29:17.516
Are you enjoying it here in South Texas? I really am. I feel like,
00:29:17.516 --> 00:29:22.586
actually, I went home to the UK recently and I came back and I thought,
00:29:22.926 --> 00:29:24.470
oh, do you know what? I'm really glad to be back.
00:29:24.986 --> 00:29:27.966
Nice. I kind of started to feel a bit more like home, actually.
00:29:27.966 --> 00:29:31.146
I was kind of driving back from the airport thinking, actually, it does feel like home.
00:29:31.529 --> 00:29:35.459
The one thing that's missing is my wife is on fellowship at the moment in Canada.
00:29:35.842 --> 00:29:42.046
So I'm hoping that you know she will at some point be becoming this way she's
00:29:42.046 --> 00:29:46.146
also a plastic surgeon so hopefully soon I remember you mentioning it the last.
00:29:47.046 --> 00:29:50.529
Time yeah two surgeons are you know struggling with,
00:29:50.987 --> 00:29:55.616
kind of two surgical careers it's not not the easiest thing but we're towards
00:29:55.616 --> 00:29:59.906
the end of training for my wife and you know I finished training a little while
00:29:59.906 --> 00:30:02.681
ago but yeah we're we're getting hopefully
00:30:03.093 --> 00:30:07.206
back into the same, we're now the same time zone, which makes a massive difference. Yeah.
00:30:07.526 --> 00:30:12.196
And weekends we can, she's in Winnipeg and we can meet somewhere in the middle
00:30:12.196 --> 00:30:14.146
in Denver or somewhere. Nice. Yeah.
00:30:14.566 --> 00:30:19.276
And what do you like to do to unplug? So I'm a big fan of swimming and actually
00:30:19.276 --> 00:30:23.386
recently taken up yoga, which does help when you're, you spend your whole day
00:30:23.386 --> 00:30:26.686
with your neck flexed, looking down into baby's mouth.
00:30:27.066 --> 00:30:31.386
Yes, I could imagine. Sometimes if I do quite If you have palate surgeries,
00:30:31.386 --> 00:30:35.676
you know, I do feel it in my neck and it's so important to look after your neck.
00:30:35.676 --> 00:30:38.301
So yoga has been a massive help, actually.
00:30:38.637 --> 00:30:41.946
I love swimming, too. And that's a great thing about San Antonio.
00:30:41.946 --> 00:30:43.706
There's some awesome pools.
00:30:44.166 --> 00:30:47.106
Great outdoor swimming. Yeah, I'm a big fan of the outdoor swimming.
00:30:47.106 --> 00:30:49.666
The moving meditation. Oh, 100%.
00:30:50.559 --> 00:30:55.646
Yeah. Well, Dr. Richard Thompson with University Health and UT Health San Antonio
00:30:55.646 --> 00:31:01.368
Plastic Surgery, talking to us here in the surgical unit right outside of the operating room.
00:31:01.867 --> 00:31:07.300
Thank you so much for talking to me today and being here on Pediatrics Now. It's a pleasure.
00:31:08.618 --> 00:31:09.668
Click on the link in this podcast.
00:31:24.984 --> 00:31:28.764
Is that what you're doing right now? Well, we already did this with debrief,
00:31:28.764 --> 00:31:33.190
but now it's just the baby waking up. It's going to go through to recovery.
00:31:33.623 --> 00:31:39.404
And it's crying, so the airway is up to fine, which is really critical for a pallet with air.
00:31:40.684 --> 00:31:45.652
Obviously, that's repairing a baby's pallet, which reduces the size of the airways.
00:31:45.942 --> 00:31:50.004
So it's always a concern of mine, certainly, when you're making the airway actually
00:31:50.004 --> 00:31:53.254
smaller, some operations you're making, when you're getting to a pallet,
00:31:53.254 --> 00:31:55.704
you're actually making it smaller. But this baby is doing very well.
00:31:56.304 --> 00:31:56.383
And so that's a wonderful cry.
00:31:58.844 --> 00:32:01.044
It's a wonderful cry. It's a wonderful cry. It's a wonderful cry.
00:32:01.064 --> 00:32:03.224
Like when the baby points. Yes, exactly.
00:32:03.984 --> 00:32:07.756
Probably really hungry, so they can usually feed straight away.