How a medical resident is helping surgeons around the world fix cleft palates

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Cleft palate repair in infants is one of plastic surgery’s toughest challenges. Now an Ontario researcher has created a better way for surgeons to practise it

When Dale Podolsky started his medical residency in plastic and reconstructive surgery at the University of Toronto three years ago, he already had impressive credentials as a mechanical engineer. But he never thought his two disparate skill sets might combine to solve one of the great challenges in plastic surgery: repairing the cleft palates of infants by operating inside their mouths.

Affecting one in every 700 babies, a cleft palate occurs when the roof of the mouth — and often the upper lip — doesn’t fully form during fetal development, causing disfigurement and an inability to eat, speak, or breathe normally. It is the most common of all birth defects, yet even experienced surgeons struggle to repair it in infants, who have small mouths and delicate oral tissue.

Podolsky’s solution? A true-to-life model of a baby’s mouth that surgeons can practise with before they reach the operating room, something so desperately needed that orders are pouring in from all over the world. University hospitals in North America and charities that provide training in developing countries — where few children have the procedure, owing to a lack of skilled plastic surgeons — believe the model could revolutionize surgical instruction.

Christopher Forrest, head of plastic and reconstructive surgery at the Hospital for Sick Children, has spent 22 years training resident surgeons to repair cleft palates and has fixed hundreds himself. Even now, he says, the procedure makes him nervous. Since only one set of hands can operate in the space, he says, “I need to have the highest trust in the trainee. Trainee performance always deviates slightly from that of an experienced surgeon, but the tolerance for deviation is very low” — in other words, one slip can be disastrous.

Podolsky has never repaired a cleft palate on his own; the task is typically assigned to senior surgery residents who have nearly completed their training, and they operate under strict supervision. Some practise the procedure on Styrofoam cups using surgical instruments, but Podolsky says that method isn’t realistic enough to be effective. Landing a residency “in the same building as some of the world’s best cleft surgeons” — and being accepted into a PhD program consisting of years of training and research — meant he had the resources and the time to come up with a better way.

The first step was to create a real-life surgical model. Podolsky spent two years working with a 3-D printer and various materials to create one featuring layers of tissues of different densities. He then took his concept to Linda Maxwell, founding director of the Biomedical Zone, a research incubator in Toronto. The facility offered Podolsky lab space, 3-D printers, and business and science advisers who would help him develop, market, and sell his creation.

He found a buyer in the New York–based charity Smile Train, which teaches surgeons around the world how to repair cleft palates and has performed more than 1 million surgeries on children in over 85 countries. The charity will deploy Poldosky’s model in Africa and Latin America “to accelerate learning and elevate the level of cleft care worldwide,” says Erin Stieber, Smile Train’s vice-president of strategic partnerships.

“Regional staff are really excited about the possibilities,” she reports, adding, “You can touch and hold it and really go through a procedure.” The model, she says, is a game changer that will be integrated into Smile Train’s current education system, which involves virtual, classroom, and operating-room training: “This could be massive.”

Cleft palate repair can transform a child’s life. Forrest says “it makes absolute sense” to invest in a surgical model that allows trainees to practise the procedure in a low-stakes environment. “The cost of something going wrong on a patient is undoable,” he says. The surgeon believes Podolsky’s model will “make a big difference in the world.”

Podolsky just travelled to Santiago, Chile, with the Canadian charity Transforming Faces, which last year performed 285 free cleft palate surgeries. “This simulator holds enormous potential as a training tool for new and experienced surgeons around the world,” board member Ronald Zuker says.

A group of 16 Chilean surgeons used Podolsky’s model to learn the procedure before returning home to begin the task of repairing children’s palates. “Ensuring cleft patients have access to safe, timely surgery is central to our work,” Zuker says. “Innovations like the cleft palate simulator could make this goal much more achievable on a global scale.”

Podolsky says he’s excited to see the Chilean doctors try out his model: “It seems people have been waiting for something like this for a very long time.”

Blair Bigham is a resident physician at McMaster University and a fellow in global journalism at the University of Toronto’s Munk School of Global Affairs.

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