I left with the team on the 26^th of February this year to travel to Dhaka, Bangladesh to participate in an educational program to help advance comprehensive cleft and craniofacial care in the country. This project has been an ongoing program of development led by Brian Sommerlad in collaboration with local Bangladeshi partners. The program for the week involved participating in a three-day conference which included presentations by both International and local Bangladeshi experts in cleft and craniofacial care. This conference also included workshops in specialist areas such as speech and language therapy, orthodontics and audiology. In addition to the conference, we held clinics with our local partners and selected complex cases which would provide good teaching opportunities for both the local surgeons as well as the conference attendees who could watch the surgeries via a video link.

My particular involvement included participating in the clinic which happened on the Saturday, 31 January and involved seeing around 30 patients. This clinic was conducted in a multidisciplinary format in a way which was intended to demonstrate how this type of clinic would be useful for the management of patients with complex medical needs. At the end of this clinic a number of patients were offered surgery on Sunday 29th January, and Monday, 30th January as teaching cases. A number of other cases were selected for the live surgery demonstrations on Tuesday, 31st January through to Thursday, 2nd February.

The first patient I operated on was a child who had a tumour of the skull base. This had resulted in a blockage requiring surgery at a very young age. The surgery was however, incomplete and there was some residual tumour which was preventing the normal development of the palate. I performed surgery to remove the residual tumour to facilitate palatal reconstruction which will enable the child to speak in the future.

The second patient I operated on was a relatively young child who had had multiple surgeries to the nose resulting in significant scarring which obstructed one nostril. This enabled me to demonstrate the use of a surgical technique called composite grafting to reconstruct the nose.

The patient that I had selected for the first day of the workshop live demonstration was a young girl who had a complex duplication of the mid facial structures. This included a secondary, accessory nose which had displaced the right eye laterally. As the accessory nose had not developed properly, there was increasing mucus tissue within the face which was not able to drain properly and represented a significant infectious risk as well as creating an increasing deformity of the face. My surgical approach was to remove all the mucous tissue and as much duplicated nasal tissue as possible. Furthermore I was able to reconstruct the bony orbit on the right-hand side and allow the repositioning of the right eye more medially.

The second day of the workshop I performed a reconstructive rhinoplasty in a patient with a complex facial cleft who had significant midface shortening and corresponding lack of nasal tip support and lip support. This allowed me to demonstrate augmentation of the midface with cartilage grafts as well as an open rhinoplasty to achieve an improved facial balance.

On the last of the workshop I gave a presentation on the management of craniofacial macrosomia which is the second most common congenital facial deformity after cleft lip and palate to over 100 delegates. After this presentation, I then performed a live surgery to demonstrate nasal reconstruction in a patient who had a post-traumatic nasal deformity. This involved harvesting of rib cartilage as well as septal cartilage to illustrate the differences in reconstructive methods.

At the end of the day I was able to meet with many of the surgeons and nurses as well as other clinicians during the evening dinner. My overall impression was that they highly valued the experience from both the didactic lectures as well as the more interactive workshops and in particular the direct observation of medical care in the multidisciplinary environment and live surgery demonstrations.

Juling pictured 8th from the right alongside colleagues from Great Ormond Street and the cleft clinicians from Dhaka. CLEFT is proud to support this multidisciplinary and collaborative approach to cleft care.

Bangladesh is a country with almost 170 million people and one of the highest population densities in the world. The health system of this nation is continuing to develop and it was a privilege to be able to contribute to the improvement of healthcare for patients with cleft and craniofacial deformity in close collaboration with the local clinicians who demonstrate complete dedication to the patients.

I am very grateful for the support of the Emirates Foundation in providing flights to and from Dhaka.

Juling Ong – Plastic and Craniofacial Surgeon