Surgeon’s Log- Cleft Surgeries

I have been asked on a few occasions to describe my feelings during and before a cleft surgery. So here goes a sneak peek for you my friend Rohit and all the readers..

Cleft lip and palate deformities as we know are congenital, meaning birth defects. Treating a facial deformity goes much beyond just doing the surgery. It is heartbreaking to see the anxiety, confusion, disappointment and fear on the faces of parents holding their bundles of joy! The reason I think clefts are different is because that flaw is out there for the world to see. It is not something you can cover up with clothing. Unfortunately, it also comes with a great extent of social stigma for the parents and if left untreated, then for the child too. It is a whirlwind of thoughts inside every cleft surgeon when they see a child with a cleft. Reassuring the parents and easing their fears is an important part of the pre operative preparation.

Once the baby reports to us, there is a checklist of things to be confirmed prior to planning repair. Age and weight being the most crucial of them. Repairs done at the right time give the most desirable outcomes, not just in terms of appearance. Once all the pre surgical criteria is met, the operation is scheduled at 0700 in the mornings, first case of the day. The baby is admitted a day before and we do a thorough pre operative work up of the child. A paediatrician then examines the baby and procures an Intra venous line, a priceless asset for giving anaesthesia that saves valuable operation theatre time and takes some weight off the anaesthesiologist’s shoulders.
The parents are asked to feed the baby only until a certain number of hours before surgery, after that nothing is to be given.

Cometh the morning I reach the OT at 0700, being a stickler for time. This helps to relax the parents who are anxiously waiting outside the OT. Our wonderful anaesthetist Dr. Trupti Pare, a mother of 2, comes in as the OT is being prepped. One of the hardest things that we have to do prior to the surgery is to take the child away from the mother and then proceed to the operating room.
The child is then gently induced into a relaxant. A very thin endotracheal tube is introduced through the mouth into the trachea. This process is critical and has all of us with bated breath till it goes in safely. I can surely say that our team ages a couple of years during those 5 minutes. The child is then covered with a baby warmer to prevent the child’s body from getting very cold also known as hypothermia ( donated graciously by Rotary Club of Pune Smart city in 2018). Prior to this we used a plastic drape to prevent a temperature drop but that method is arbitrary.
Scrubbed and ready to go we finish the operation with precision and with critical evaluation of each step that we take. Magnification loupes are used to optimise results, as we believe that the first chance is the best chance.
The operation is now done and the child is reversed out of anesthesia. The sound of crying feels like music to the team’s ears.
It is then time to take the infant back to their parents. It is in these moments that their tears of joy make everything worth all the effort. That for me is the icing on the cake, the gratitude of the mother and father. All my children with cleft have a piece of my heart!
Thank you Jaideep Bhai, for making me a part Rotary Club of Pune Smart City.
I am blessed to have your support, Team Rotary!

Yours in gratitude,
Pushkar Waknis
Maxillofacial Surgeon, Pune