Interplast is an organization of Doctors, Nurses, and other Medical Professionals who travel to over 25 nations around the world.Their mission is to provide free plastic surgery to children in poor nations.

On January 17th, 1999 a team of three surgeons and three anesthesia doctors traveled to the distant country of Laos on a most special mission. Laos, a country of about 5 million people has no plastic surgeon. As a country in desperate need of modern medical care, Laos was identified as a destination of Interplast.

Dr. Rebecca Jackson, Dr. Brett Snyder, and Dr. Howard Sutkin traveled to Laos in order to treat children in need of reconstructive surgery. With a team of ten Americans, twenty four boxes of equipment were loaded onto Los Angeles based Thai Airline's daily trip to Bangkok. Once in Bangkok, a short flight to the Capital City of Laos was made. Clinic was held on the first day revealing most of the problems to be cleft lip and palate. Immediately the operating rooms were readied for a week of operating into the darkness of night.

The primary operations which we performed included cleft lip and cleft palate. A cleft lip is in simplified description and abnormal forming of the lip tissue prior to birth. The deformity is highly variable and may be seen ranging from a slight notch in the upper lip below the nostril, to a large amount of apparent missing tissues with a "hole" between the nostril and the mouth. The anatomy of a cleft lip is an area of intense study and descriptions of its features helps physicians in planning a surgical repair. Usually, in a typical cleft lip one will see a rotation of the vermilion (red tissue of the lip) up into the nose on both sides of the deformity. Also, deep to the skin, the lip muscle, which normally forms a ring around the entire mouth, connects up into the floor of the nose. As the child develops in the uterus, the abnormal positions of muscle fibers and soft tissues actually causes the bones of the nose and face (maxilla) to splay open and this widens the appearance of the face on the cleft side. This effect has serious consequences on the bones which hold the teeth and the cartilages of the nose which also become deformed.

Surgery of the cleft lip has a history of its own. Early writings about attempts to repair a cleft lip include simple plans to attach one side of the cleft to the other. In all but very minor cases, this yields sub optimal results with abnormal form and function of the lip. Todays techniques are aimed at rotation of tissue down from the nose and realignment of the lip muscle, called the orbicularis oris. When properly aligned, this muscle adds fullness and motion to the lip which is paramount in camouflaging the cleft. Surgery is done in steps. First a local anesthetic is added to help minimize the bleeding and to provide post-operative comfort. Second, cuts are made to recreate the defect and to loosen the tissues from their abnormal positions. Third, the sutures are placed in order to achieve mucosal closure in the mouth and nose, to restore muscle continuity, and finally to repair the external surface of the skin.

Following cleft lip surgery, children are awakened from anesthesia and placed on mild pain medications. Sutures may need to be removed after about five days of healing. Usually the children act as if nothing has happened the next day, but I don't recommend wearing a white coat when visiting them because they frequently remember it being a bad sign for them the day before.