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OPERATION SMILE CLEFT SURGERY TRAINING

PROGRAMME INDIA

FINAL REPORT

MAY – JULY 2015

Dr Kamau Martin (MDS-OMFS)

Department of Human Anatomy

School of Medicine

University of Nairobi

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TABLE OF CONTENTS

TITLE PAGE……………………………………………………………………………………………………… 1

TABLE OF CONTENTS……………………………………………………………………………………… 2

EXECUTIVE SUMMARY……………………………………………………………………………………. 3

TRAINING PROGRAMME BACKGROUND………………………………………………………… 4

OBJECTIVES……………………………………………………………………………………………………. 6

PERSONAL EXPERIENCE…………………………………………………………………………………. 6

KEY LEARNING POINTS/OUTCOMES……………………………………………………………… 11

OPPORTUNITIES…………………………………………………………………………………………… 11

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SUMMARY OF EXPERIENCE…………………………………………………………………………… 12

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EXECUTIVE SUMMARY

Background

The training programme encompassed rotation through two centres of

excellence in India that provided training in facial cleft care and craniofacial

surgery as well as attendance of a craniofacial symposium and workshop.

1: Guwahati Comprehensive Cleft Care Centre in Assam, India

2: Maaya Foundation for Craniofacial Surgery in Bangalore, India

3: Amrita Institute of Medical Sciences, Kochi, India

Objectives

The key objective was to improve knowledge and skills that would enhance my

approach to the management ofcleft and craniofacial patients as well as provide

a solid foundation for research and teaching in clefts and craniofacial biology at

the University of Nairobi.

Key learning outcomes

Gaining knowledge and skills in cleft care, craniofacial and aesthetic surgery

while also gaining exposure to novel areas of research in craniofacial biology.

Opportunities that have arisen

1: Inter-institute colloboration in training and research

2: Continuing training opportunities at these centres of excellence

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TRAINING PROGRAMME BACKGROUND

The Operation Smile Cleft Surgery Training Program is an internationally

acclaimed fellowship aimed at empowering surgeons particularly from

developing countries to gain the requisite skills in the management of facial

clefts as well as complex craniofacial malformations. It encompassed rotation

through two different centres in India as well as attendance of a craniofacial

workshop.

1: GUWAHATI COMPREHENSIVE CLEFT CARE CENTRE, ASSAM,

INDIA.

GC4 is the largest comprehensive cleft care centre in the world having

successful operated on over 15000 cases since its inception in 2011. It was set

up as part of a private-public partnership between the Government of Assam

and Operation Smile International (an American based NGO that focusses on

cleft care) at the Mahendra Mohan Choudhary Hospital in Guwahati.

Guwahati Comprehensive Cleft Care Centre

Left to right. Dr HemantaKalita (staff surgeon), Dr Kamau Martin, Dr HiteswarSarma (Medical Director-GC4)

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2: MAAYA FOUNDATION FOR CRANIOFACIAL SURGERY,

BANGALORE, INDIA.

Maaya foundation for Craniofacial Surgery was incorporated in 2006 by

Professor, Dr Krishna Shama Rao with the vision of providing comprehensive

care to patients who have complex Craniofacial malformations. Prof Krishna is

one of only 12 surgeons worldwide to be awarded the Hugo Obwegesser award

for Corrective Surgery of Craniofacial Skeletal anomalies as a pioneer in this

field in India.

Maaya Foundation

From left to right: Dr Chetana, Mr Prashant, Professor Krishna Shama Rao, Dr Kamau, Ms Lima, Dr Tarun, Mrs Rao

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OBJECTIVES

The main objective was not only gaining competency in cleft and craniofacial

surgery but also improvement of knowledge in this area that would enable me to

expand the scope of Craniofacial Biology as a thematic area in the Department

of Human Anatomy, University of Nairobi.

1: To improve competency in Cleft and Craniofacial surgery.

2: To improve knowledge and skills in craniofacial biology and surgery.

3: To identify areas of institutional collaboration in training and research on oral

and craniofacial biology.

PERSONAL EXPERIENCE

I was exposed to comprehensive cleft care as well as principles of management

of complex craniofacial malformations. The scope of management covered cleft

surgery, orthognathic surgery to complex craniofacial surgery. Additionally,

there was the incorporation of aesthetic surgery to add to the component of

‘finishing’ surgery’! This included experience in cosmetic procedures such as

mesenchymal stem cell facial revunation, rhinoplasty, hair transplants and other

cosmetic procedures. The principle behind this was to encompass reconstruction

of facial deformities and include the final facial cosmetic procedures for holistic

treatment.

The fellowship also combined didactic presentations and rigorous question and

answer sessions in the broad area of craniofacial malformations to further

enhance the learning experience.

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CRANIOFACIAL SURGERY: Clinical photo sequence - 3year old girl

undergoing facial bipartition procedure to correct hypertelorism

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AESTHETIC SURGERY: Clinical photo sequence of hair transplants

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CRANIOFACIAL SYMPOSIUM AND WORKSHOP

Further, I attended a craniofacial symposium and workshop at Amrita Institute

of Medical Sciences that brought together India’s top craniofacial surgical

teams to discuss the scope of craniofacial surgery, their surgical experiences as

well as the future of craniofacial surgery such endoscopic approaches in the

management of craniosynostosis.

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Craniofacial symposium and workshop conducted at Amrita Institute of

Medical Sciences at Kochi, India.

Correction of anterior plagiocephaly on STL model

Leforte III osteotomy on a dry skull

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KEY LEARNING OUTCOMES

Training

1: Competency in facial cleft surgery

2: Exposure to Craniofacial surgery with competency in craniosynostosis

management

3: Exposure to craniofacial aesthetic surgery with emphasis on mesenchymal

stem cell facial rejuvenation, cosmetic rhinoplasty and hair transplants.

Research

Exposure to novel areas of craniofacial biology research with useful clinical

applications such as mesenchymal stem cells in craniofacial rejuvenation.

The benefit of the above lies not only in being a better clinician but also in

understanding the area of craniofacial biology to enhance the development of

this area as a vibrant thematic section in the Department of Human Anatomy,

University of Nairobi.

OPPORTUNITIES THAT HAVE ARISEN

Research and training colloboration

1: Inter-centre/institution cooperation for training in Cleft and Craniofacial

Surgery

Having rotated through Maaya Foundation, an opportunity arose for cooperation

between the foundation and University of Nairobi, Department of Human

Anatomy. One possibility is conducting surgical training workshops in

craniofacial surgery through the Nairobi Surgical Skills Centre.

2: Research collaboration between the international centres.

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Research in craniofacial development anomalies to better understand

craniofacial biology and improve management of these conditions is a potential

inter-institute area of collaboration particularly when looking at different

population settings and any peculiarities that may be seen.

Fellowship programmes

Development of human resource in the area of oral and craniofacial biology

particularly for Nairobi University staff through fellowship programmes in the

aforementioned institutes in India.

SUMMARY OF EXPERIENCE

The experience the training programme has been an ‘eye opener’ not only in

gaining clinical experience in the unique and complex area of craniofacial

surgery but also knowledge and ideas in how to develop the thematic section of

Oral and Craniofacial biology in my Department at the University of Nairobi.

The hope is that this thematic section will be made vibrant in terms of training

at the graduate and postgraduate level as well as research in craniofacial

biology. Further, the interaction and links created with the institutes provide for

opportunity to collaborate in training and research in craniofacial biology and

surgery. In conclusion, I believe that this programme has given me the tools to

embark on this journey to expand the knowledge base and technical skill in this

unique area of craniofacial biology and surgery.