The Newsletter for SUNY Downstate
University Hospital of Brooklyn
ISSUE 17 OCTOBER 2013
Greater Brooklyn Cleft and Craniofacial Team Restores Smiles for Young Patients
An orofacial cleft is an opening in the lip and/or at the roof of the mouth and is one of the most common birth anomalies, affecting as many as 1/1000 children born each year in the United States. Brooklyn has the highest number of births of all boroughs in New York City, making attention to clefts and other birth anomalies an important priority for physicians and other clinicians.
Surgical repair is staged during the first year of life, beginning with repair of the lip followed by repair of the palate. In most cases, by the time the child is one year old, the lip and palate have been reconstructed, which affords patients the best functional outcomes. Development of normal speech and symmetry of the upper lip are the goals for all patients.
Sydney C. Butts, MD, FACS, chief of facial plastic and reconstructive surgery in the Department of Otolaryngology, specializes in helping children born with this condition get a good start in life. Before coming to Downstate, Dr. Butts trained at SUNY Upstate, which has a very active cleft team. "It was a great experience," she says, "and what attracted me to Downstate was the opportunity to create a much needed service here."
Over the past four years, Dr. Butts has worked to develop a multidisciplinary team of physicians and allied health professionals at Downstate that networks with other Brooklyn medical centers to provide coordinated services for children with cleft lip and palate. In addition to surgical intervention, the Greater Brooklyn Cleft and Craniofacial Team works closely with the staff of the Infant and Child Learning Center at Downstate, the neonatal intensive care unit, and with other pediatricians, dentists and speech pathologists that treat cleft disorders.
These conditions encompass a wide spectrum, Dr. Butts explains, sometimes not manifesting themselves until later in childhood.
In most cases, however, malformations are evident at birth and often can be detected in utero. This enables the Downstate cleft team, working closely with the OB service and the NICU staff, to educate and prepare parents in advance for the surgery and follow-up care their infants may require.
Earlier this year, the team published a brochure "The Care of a Child with Cleft Lip and Palate: A Guide for Parents" to provide information to families caring for children who are referred to the multidisciplinary team. The PDF is available here.
Dr. Butts provided hope to children in Rwanda with the Free the Future Fiundation. In addition to serving the Brooklyn community, Dr. Butts has visited Viet Nam and other countries in need of her surgical skills. Earlier this year, she went on a medical mission to Rwanda along with five other otolaryngologists/ facial plastic surgeons that was sponsored by the Face the Future Foundation.
Rwanda has only one plastic surgeon serving a nation of 11 million people. As a result, many adults and children with facial deformities since birth or as a result of trauma or cancer remain untreated.
Dr. Butts and the other members of the team worked at two main hospitals in the capital city of Kigali, evaluating and treating patients with congenital craniofacial disorders, facial injuries due to trauma, head and neck tumors, and secondary deformities after tumor removal. They operated on 17 patients suffering from a wide range of problems. Some surgeries lasted 10-12 hours. In one case, an exploded hand grenade had destroyed the lower half of the patient's face. Working together to perform microvascular reconstruction, the surgeons used donor bone and tissue to sculpt a new face.
"The end results were so rewarding," says Dr. Butts, recalling the hugs the team received from grateful patients and their families. "I gain a deeper appreciation of how fortunate we are in the United States to have modern conveniences and state-of-the-art medical tools and technologies after these international trips. The experiences provide motivation for the work I do in Brooklyn to ensure that our patients have access to well-coordinated care."