Cosmetic Surgery Day 2 - Jack

Today I was suppose to meet with the senior resident, but something came up so Dr. Y.C. Por, a fellow from Malaysia, met with me at the bus station, and we headed to the Taoyuan hospital. Dr. Por was kind enough to explain to me how a cleft pallet and lip is repaired. He explained to me the Millard rotation and advancement procedure. It was a great lesson, eventhough the topic was new, the anatomy that we just learned was the key to understanding it. The tensor palatini was used to create the roof was the pallet, but unfortunately the tensor levator had to be resected which often leads to problems within the eustacian tube such as infections. Throughout the day, multiple cleft pallet or lip repair were going on among two unique procedures.
The first stand out procedure was a stage 2 ear reconstruction. A long procedure that took close to 9 hours. Cartilage was harvested from the 9th rib and used to create the ear shape and underlying support. A flap was created from the scalp and overlayed onto the shaped-cartilage.

The second fascinating procedure was an orthognathic (Jaw) surgery using the “Le Fort I” osteotomy. [Le Fort I osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. The maxilla is fixed in its new position with titanium screws and plates. The operation is frequently carried out with the mandibular Sagittal split osteotomy when it is termed a Bimaxillary Osteotomy.]

Today’s cases and procedures observed:

Case 1
1 yo male cleft pallet repair

Case 2
3 mo female cleft lip and pallet repair

Case 3
6 mo preaxial polydactyl (extra thumb) resection

Case 4
30 yo male Le Fort (I) osteotomy
Retraction of the upper jaw 3mm, and protraction of the lower jaw 7mm.

Overall, a tiring day of standing but well worth it. I saw so many fascinating procedures and doctors here were extremely helpful and approachable. I was often within less than a foot away from the action.

After my shift....

At night we all went out to eat Chinese beef noodle soup, except for Bill who had fallen asleep in the library...or perhaps he is a "undercover gunner"? (j/k)