SD Union Tribune article – Dr. Bucko

By Erin Hutkin, Special to U-T San Diego   6:00pm   Dec. 2, 2014

“On Oct. 19, Dr. Dennis Bucko – a plastic surgeon affiliated with Scripps – left for Mexico with a team of 35 medical professionals.

The group, the Mercy Outreach Surgical Team, spent a week in the country treating an estimated 300 to 350 children and adults with limited access to health care.

During the trip, Bucko helped some of those children who were born with a cleft palate, one of the world’s most common birth defects.

It’s a condition in which the tissue that makes up the roof of the mouth, the palate – which is formed between the sixth and ninth weeks of pregnancy – doesn’t join completely together during development. In some babies, both the front and back parts of the palate remain open, while for others, only part of the palate is open.

Bucko said the defect occurs in roughly one of every 750 births, and while it’s normal for the condition to be surgically fixed in the U.S. starting in infancy, those in less-developed countries such as Mexico may not always have access to the medical care needed.

For instance, he said, he repaired a cleft lip of an 80-year-old woman during a surgical team trip to Mexico. She told her medical team she was going to die soon, and when she goes to heaven, she wanted to look good.

Yet, while the problem is treated in the U.S. at a young age, correcting a cleft palate is a process that can take several surgeries and span most of a person’s childhood and teen years. It also requires a team of professionals — everyone from social workers and plastic surgeons to speech therapists and dentists.

While the cause of a cleft palate is unknown, Dr. Michael Nelson, a general pediatrician and medical director of Kaiser Permanente’s cleft and craniofacial clinic, said when a baby is born with a cleft palate, a genetic counselor is often consulted to determine whether the issue is an isolated defect or part of a larger genetic syndrome.

In addition, he said lactation consultants help parents with feeding methods because babies with cleft palates can’t generate the pressure needed to suck milk from a bottle or breast. Because babies born with the defect are more likely to have middle-ear problems, he said an ear, nose and throat doctor will be consulted and tubes might be placed in the ears when surgery is done to repair the palate. This can improve hearing and prevent fluid buildup in the middle ear.

If a baby is also born with a cleft lip — a physical split of the two sides of the upper lip – he said, this is repaired when the infant is 3 to 5 months old.

However, he said, “The lip is just the tip of the iceberg.”

Nelson said lip surgery is followed by an operation to repair the palate when the baby is 8 to 12 months old. From there, he said the child’s speech is evaluated at roughly 18 months, as those born with cleft palates often need to retrain the muscles for effective speech.

In addition, he said, when the child is between 6 and 10 years old, he or she may need to have a hole in the gums repaired. He said this is often done by grafting a piece of bone from the hip to patch the hole in the gum. This sometimes involves pulling or moving teeth, and if so, an orthodontist or oral surgeon is involved.

As the child grows, he said, doctors also watch the growth of the jaw, and if the person’s bite is not what it should be, surgery might be needed in the late teen years to bring the jaw forward. In some cases, a rhinoplasty may be needed to adjust the structure and appearance of the nose.

“They’re major surgeries,” Nelson said. “The care of a cleft child is complex and long-term.”

On the plus side, he said those who receive the right surgical care can go on to look like they were born without a defect and live healthy lives.

“In experienced hands,” he said, “(treatment) is usually very successful.” ”