Earlier this year, Mr Juling Ong traveled to Dhaka to advance comprehensive cleft and craniofacial care in Bangladesh. He participated in a three-day conference with both international and Bangladeshi experts. In addition, Mr Ong held a clinic, seeing approximately 30 patients, before operating on selected complex cases which provided good teaching opportunities for both local surgeons and those watching the surgery via a video link.

“The 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 as teaching cases.”

Demonstrating Craniofacial Deformity & Reconstruction Surgery

“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.

Multidisciplinary and collaborative approach to cleft care

“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.”

Click here for more information on Juling’s trip to Bangladesh and the work of Cleft, which provides long-term, sustainable ways to improve cleft care both in the UK and overseas.