Of course the cleft lip repair can make a dramatic difference in a child's life. In an hour and a half, the skilled hands of a plastic surgeon, with the help of the Rotaplast team, can change a little girl or boy's destiny from being shunned by family and society alike, to a normal-looking, smiling, laughing, playful child who is ready to take on the normal challenges of everyday life.

There are results everyone can see. We can witness the transformation, and the inevitable "oohs and ahhs" in the recovery room remind everyone why we travel thousands of miles to do this rewarding work.

However, the cleft lip repair is only part of the work we do during a Rotaplast trip. In addition to the "glamorous" restoration of the cleft lip, the plastic surgeons spend a great deal of time with our hands deep in a place barely visible to even our scrub nurse in the operating room. Our big fingers and hands work in a cavity barely a few inches in diameter, like a craftsman assembling a ship in a bottle. A cleft palate is a split or separation in the "roof of the mouth" which is also the floor of the nose. The cleft can involve the bony "hard palate" which also serves as a foundation for the teeth, and/or the soft palate, located way in the back of the throat, which also is connected to the uvula, the small fleshy "little tongue" that hangs in the back of the throat, the small piece of flesh subject to some folklore and mystery.

The child with an un-repaired cleft palate can suffer from a variety of maladies, from the aforementioned dental misalignment, poor nasal-oral hygiene, frequent ear infections that can lead to hearing loss, and most importantly and dramatically, poor speech that in some cases can be almost to impossible to comprehend. These children can be reluctant to raise their hands in school, refuse to converse, and be mistakenly considered to be unintelligent because of their reluctance. They can be subject to intense ridicule and bullying because of their reluctance of speech itself, which can lead to isolation, typically expected for the  patien with an un-repaired cleft lip.


It is for these reasons why the plastic surgeon will lean and bend into this small cavity in the back of a baby's mouth, for hours at a time, tolerating suboptimal lighting, room temperatures, and noisy suction machines, performing a relatively misunderstood and unglamorous operation to rearrange the tissues responsible for speech. It may be a Z-plasty (furlow) repair, a pushback method, an intra-velor veloplasty, or even an operation on the back of the throat itself, called a pharyngoplasty. These back and neck stretching operations are all designed with the same outcome in mind; to restore a child’s ability to speak.


It is a gift that cannot be pictured on a poster or in an ad and shown at fundraisers. It doesn’t easily lend itself to a "before and after photo" during a report to supporters, it is not described by a catchy phrase like "saving smiles," and at times these palate operations take a backseat to the cleft lip repairs. However, it is a gift that can make it possible for a child to speak clearly to his parents about his wants, answer a question in school with confidence, or one day give a speech that can move the audience, or actually one day in the future reveal what is truly in her heart – it is the gift of speech.


Thanks for being so gracious.

by Dr. David Morwood, M.D.