INTRODUCTION

The Plastics and Reconstructive Unit at PMGH was re-established in 2021 after a decade of inactivity due to the absence of a specialist. Dr. Jackson Nuli completed his training and reformed the unit in 2022. Since then, trainees Dr. Moses Maire, Dr. Mitchel Masin, and Dr. Kaycii Amoko have joined the team.

The unit handles various cases, including cleft lip and palate, chronic wound management, and tendon and nerve repairs, amongst many other plastic cases. Due to limited theatre space at PMGH, many patients are on the waiting list and face financial difficulties travelling to Port Moresby. To address this, the team collaborates with NGOs and PHAs to fund visits to other hospitals, reducing costs and serving more patients.

This program was initiated, organised, funded, and coordinated by the Rotary Club of Boroko under its ROMAC Program. In collaboration with Arawa Rotary Community Corps, Air Niugini, and Buka General Hospital, it aimed to provide specialised services to patients who could not travel to PMGH, especially for cleft lip and palate repair surgery. This report outlines the cases, challenges, and recommendations for future programs.

[caption id="attachment_1631" align="alignnone" width="2560"] L-R. Dr Jackson Nuli, Mr Joselito Tubon – Director of ROMAC in the Rotary Club of Boroko, the major sponsors, Air Niugini staff presenting tickets, and Dr Kaycii Amoko.[/caption]

CLEFT LIP AND PALATE

Cleft lip and palate are congenital birth defects that arise during embryonic development when the upper lip and palate fail to fuse. These defects affect the appearance and functions associated with these structures. Some children have only cleft lips, while others may have both.

The lips provide a normal aesthetic appearance and allow acceptance into a community. Thus, it is very challenging for parents to have a child with a cleft lip. As children age without this being repaired, they often miss out on education, social activities, and personal growth due to its stigma. Correcting this defect at an early age, at least before the age of two, is very important.

With cleft palate, speech development is affected. When the cleft palates are not repaired after age one, there is a high chance that they will have speech difficulties in the future, even when the palate is repaired. Therefore, it is vital to repair the cleft palate by the age of 1 year, as this is the time they begin learning to talk. Cleft palate repair is done primarily to help the patient develop proper speech.

POOR DENTAL OUTCOME WITH LATE PALATE REPAIR

Apart from speech difficulties, a significant issue with delayed repair of the cleft palate is poor dentition. The dentures are malaligned with the patient's age and growth, creating a disfigured oral cavity that may be prone to dental disease and injury.

Early cleft palate repair is a solution to improving dentition for these patients.

CLEFT LIP AND PALATE SURGERY

In PNG, we prefer to repair the palate before lip repair for patients with cleft lip and palate. The two main reasons are: firstly, the patients often present late after age one, so it is crucial to repair the palate to allow speech to be developed. Secondly, when the lip is repaired first, the parents or guardians often fail to bring in the patient for palate repair. Therefore, the palate is repaired first; they will bring in the patient for lip repair later as the lip defect is visible.

We often do stage repairs. So, after repairing the palate, we do lip repair 4 – 6 months after the first surgery. This allows time for the patient to heal entirely before undergoing another surgery.

PLASTICS SURGERY IN BUKA GENERAL HOSPITAL.

In 2008, the Interplast team from Australia visited Buka Hospital and operated on cleft lip and palate patients. Between 2008 and 2011, local surgeons Dr Beaso and Dr L. Pulai visited Buka General Hospital and performed some cleft lip repairs.

It has been fourteen years, and another visit has occurred, this time by the local Plastics Reconstructive Unit from PMGH. This has resulted in a buildup of cases not receiving surgery at the required age, and the effects may last their lifetime.

[caption id="attachment_1632" align="alignnone" width="1058"] Different teams working together to ensure the patients receiving cleft lip surgery are given the best care and support during surgery.[/caption]

AWARENESS

It has been a challenge to raise proper awareness of our visit. With good awareness of our visit, we would expect a good turnout from patients suffering from cleft lip and palate. It is also essential that parents or guardians present to the hospital early and find out about such specialist visits so they may receive these services when a team travels into Buka.

SPONSORS/ACKNOWLEDGEMENTS

1. Major Sponsor: Rotary Club of Boroko.
2. Airfares sponsored by Air Niugini through their community engagement program.
3. Arawa Rotary Community Corps.
4. Buka General Hospital.
5. Port Moresby General Hospital.
6. Plastics, Head and Neck Unit, PMGH.