Report from CaboSmiles Mission to Mexico February 2024

Partnership Projects of Children’s Lifeline™ & Smiles International

  • Number of patients screened for review: 50
  • Number of cases selected for reconstruction on 4.5 day mission surgical days: 17
  • Total number of cases operated: 17
  • Surgical reconstructive procedures performed: 59
    • (reason for multiple procedures performed under the same pediatric anesthesia; it was performed this way in order to make best use of the opportunity for child’s overall safety with less exposures to anesthesia throughout care.)
  • Relative value of cases if performed in the USA at hospital setting with specialist anesthesia , surgeons, and nursing facility charges: $367,450.00 USD

Clinic Flow

We start moving over to the clinic at the very crack of dawn in the city, which gives us a moment of absolute AWE, appreciating all that we have been blessed with.

We bring downstairs the crates and shelves left in storage from previous missions and begin to set up the hospital operating rooms. Within just a few hours we are ready for early confirmation screening to jumpstart the week.

Screening is done simultaneously with hospital setup. Pre-verified cases that were gathered by our support team by remote telephonic and Internet means are evaluated for their current health status. Scheduling is done for the week’s cases and given appointment instructions. Some are selected for surgery on the first day if their parents have prepared the children properly.

Several children were seen with Syndromes that were associated with cleft lip or cleft palate deformities. This family had a genetic transference of Aperts Syndrome with hand & feet abnormalities, as well as facial/ocular/orbital and cranial developmental genetic issues, combined with cleft palate. The boy was evaluated with a pre-visit echocardiogram due to his Aperts condition, and was deemed stable and approved for pediatric general anesthesia and his cleft palate repair surgery.

This young lady has dolico-cephalia and infraorbital hypoplasia combined with syndromic clefting of the palate with extra digit formation in the shape of a “thumb-heart” that she was using in school to spread “love kisses.” The palatal defect was adjusted to give muscular closure for better speech and palatal lift function.

First Infant Case of The Day

The first baby of this clinic with bilateral full lip and palate clefting was accepted for sunday surgery, having arrived NPO and ready for surgery.
Surgical team huddles for review of the day’s cases
The baby is given a gentle breathing induction and an IV was then started for anesthesia medication access
Then, the surgical team goes to work for this case taking approximately 2 hours. Added nasal cartilage repositioning as well as muscle anastomosis is performed, in addition to the closure of the lip, taking advantage of the pediatric anesthesia availability.

The recovery and CRNA nurses have smiles on their faces, as well as the family, for this wonderful result.

The Team

Team members working at the February 2024 CaboSmiles clinic:

At the end of the week, by popular news media request, Dr. Moses gives a press conference called together by the ROTARY CLUB of Los Cabos where he presented the results of the mission week’s children’s surgeries, summarizes the philosophy of the continuous longitudinal care for cleft challenges children, and the importance of partnerships formed with Children’s Lifeline International, so that necessary materials and logistical funding can make it all possible. Mrs. Moses, the Foundation’s vice president and patient coordinator interprets for Spanish speaking news personnel.

Patients Returning for Additional Procedures

Out of the more than 355 children’s cases in our immediate active files, many children who were returning found themselves able to receive their next staged surgical procedures. Additionally on this February mission, there were 2 new primary cleft lip births presenting to this clinic, and 3 primary open palates, with one returning from the August clinic who was too young as a newborn to operate at that time. His family was told to return to this February mission clinic and the surgery was accomplished, further exemplifying the importance of longitudinal cleft mission care programs.

There also were 3 challenging syndromic patients with craniofacial anomalies associated with their clefting that not only required from our surgeons additional thought and planning for the scheduling of their full treatment plan, but also extra care from the pediatric anesthesiologists to manage some of the concomitant medical issues present with these syndromes.

Other patients filled the rest of the week with their longitudinal and full-service treatments. A dramatic lip change on the face is always wonderful to put out in the news, but a functioning patient that, due to the longitudinal philosophy of our missions, is able to have their 5-7 stages of reconstructions performed with the correct growth timing is crucial for them to enter society with the ability to eat, speak, breath, and hear properly. This philosophy, in our view, outweighs the glamor of “surgery just for the “SMILE” as we have mentioned before in past reports. Indeed, “Form Follows Function” as the famous pediatric Geneticist-Orthodontist, Melvin Lionel Moss (1923 – June 26, 2006) once said.

During this clinic we were able to secure and confirm the support of another modern and spacious hospital. The H+, or Hospital “Mas” center was at first built by the Scripps Hospital system of San Diego, but was bought out by private investors in Cabo San Lucas. The story goes, from an insider’s view, that one of the USA ex-pats that lived in CSL once had a visiting family member experience an emergency appendix infection which required a surgery that was not available at the time. They went on to organize a collaborative effort with the Scripps Hospital which resulted in the opening of H+ medical hospital.

Whatever the origin, we are blessed to have their commitment to allow us to operate the skeletal orthognathic stages of surgery for one of our children who had already been brought through the stages of Lip, Palate, Speech Pharyngeal Surgery and bone grafting for her Maxillary Alveolar cleft deficit. She had undergone 2 years of orthodontic care donated by the team’s local collaborating business, MaxiMed’s orthodontist, Dr. Carlo Caballero.

She is ready for this otherwise expensive and unavailable surgery, and has been waiting several years for us to purchase all the necessary equipment and arrange the surgical and anesthesia team, as well as the appropriate medical center to provide her surgical care. This is planned for the next mission trip between August 3-10, 2024. The surgeon operating in August was invited to join us for this February 2024 mission so that he could take the records needed to create the specialized surgical 3D modeling and provide the surgical operating guide for the August mission. Her side photo is here showing the severe midface retrusion which results from these cleft cases having significant pulling back of growth of the upper jaw, following multiple surgeries in their childhood.

This surgery is like the one shown here, performed by Dr. Moses during a Costa Rica mission which brings the upper midface forward to function better, thereby bringing “Form to Function” to these children.

The joint efforts of the Children’s Lifeline International and the Smiles International Foundations give hundreds and, indeed over the prior 40 years, thousands of children afflicted with facial cleft differences and deformities hope for a more normalized future, allowing them to grow and flourish in their communities. Abilities to eat, speak, breath, hear and SMILE cannot be underestimated in their value to allow integration into their communities as functioning young adult members of the work force.

Prof. Jeffrey J. Moses DDS, FAACS, FADI, FICD, FACD, FPFA
Diplomat American Board Oral/Maxillofacial Surgery
President, Founder Smiles International Foundation

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