Surgery Rona Slator Consultant Plastic Surgeon Clinical Director, West Midlands Cleft Centre - PowerPoint PPT Presentation

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Surgery Rona Slator Consultant Plastic Surgeon Clinical Director, West Midlands Cleft Centre

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Surgery. Rona Slator. Consultant Plastic Surgeon. Clinical ... Development of basic science research that might fundamentally change the surgery needed ... – PowerPoint PPT presentation

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Title: Surgery Rona Slator Consultant Plastic Surgeon Clinical Director, West Midlands Cleft Centre


1
SurgeryRona SlatorConsultant Plastic
SurgeonClinical Director, West Midlands Cleft
Centre
  • CLAPA Annual MeetingSaturday, 11th October, 2008

2
The service providedDevelopment of that
serviceProblems/challenges for the future
3
Surgery - the serviceto try to restore the
disrupted anatomy
4
0-5 years3 months lip repair 6-9
months palate repair closure of
fistula surgery for speech lip/nose
revision
5
5-10 years closure of fistula surgery
for speech 8-10 years alveolar bone
graft lip/nose revision
6
10-20 years lip/nose revision gt16
years lip/nose revision orthognathic
surgery implants
7
(ENT surgery for glue ear)?
8
But surgeons also
  • Often visit newborn babies and their families
  • Counsel parents who have had an antenatal
    diagnosis of their baby having a cleft lip
  • Continue support for families as the children
    grow up

9
  • With geneticist and paediatrician will have a
    role in diagnosing other anomalies and/or
    developmental problems
  • Engage and liaise with specialists (both within
    and) outside the cleft team in coordinating care
  • May have a major role in looking after babies
    with Pierre Robin Sequence with airway/feeding
    problems

10
Teaching/training
  • Surgeons
  • Other members of the cleft team in training
  • Other specialties outside the cleft team but also
    involved in the care of children with cleft lip
    and/or palate
  • Being open themselves to learning from other
    specialists in the cleft team

11
Development of the surgical service
12
Following CSAG and reorganisation
  • Reduced numbers of surgeons involved in cleft
    care
  • Increased time commitment of surgeons to cleft
    care (particularly for those involved in
    primary surgery)
  • All surgeons carrying out primary lip and
    palate repair treating increased numbers of new
    babies (range in 2008, 29-77 per year)

13
Developments - Surgical training
  • Significantly improved and specific training (1-2
    year Cleft Fellowship) for trainee surgeons
    wishing to become consultant surgeons carrying
    out primary cleft lip and palate repair.
  • Currently there are talented young surgeons
    interested in the specialty

14
Developments
  • Coordination of care improved following
    reorganisation all aspects of cleft care within
    the one team
  • Longitudinal care established
  • Colleagues with whom to discuss difficult or
    unusual surgical problems
  • Other specialist disciplines within the team
    contribute to surgical decisions

15
Developments
  • Measurement of outcomes
  • There is a more open culture about outcomes and
    intercentre audit
  • And a desire to improve care by working together
  • Continuing effort to move towards the CSAG
    inspired standards of multidisciplinary care
    (ENT, impact of psychology input)

16
Challenges for the future
17
Challenges
  • Developing evidence to support best surgical
    practice

18
So, for example, order and timing of repair of
lip and palate
  • Unilateral cleft lip and palate
  • Lip all of palate
  • Lip/(anterior) hard palate rest of palate
  • Lip and soft palate rest of palate
  • 3 months 6-9 months

19
An easier question?
  • Which sutures to use?
  • Still have at least one problem of outcome measure

20
ChallengesOutcome measures
  • Speech
  • Facial growth
  • Appearance/symmetry
  • Well being
  • burden of care

21
plus
  • Small numbers
  • Workload and infrastructure to collect data
  • Having equipoise for different approaches

22
ChallengesAnd evidence from
  • Developing a better understanding of the
    patients views on surgery, particularly so
    called secondary surgery.

23
Challenges
  • Development of basic science research that might
    fundamentally change the surgery needed

24
Challenges - A very specialist area
  • Continue to attract the best young surgeons
    into the field
  • And train them so that the learning curve is
    eliminated as far as possible
  • Who will have wide knowledge and awareness of
    surgical and technical developments in all areas
    of surgery and elsewhere so that these can be
    introduced into cleft care where appropriate
  • Innovation
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