In the business of smiles
Fourteen years of cleft lip and palate surgeries later, this doctor still relishes the opportunity to transform his patients’ looks — and lives
His patients are sometimes a week old. Parents filled with trepidation at the prospect of a surgery on their tiny wards have to be convinced that no matter how painful, it’s best if interventions are done when their children are young. As someone who has been performing cleft lip and palate surgeries for 14 years, DrKrishnamurthy Bonanthaya has reformed scores of lives, of both young children and adults.
When we meet the maxillo-facial surgeon at Bhagwan Mahaveer Jain Hospital, it is a busy afternoon, with patients and their anxious parents lining the waiting area. The procedure, he asserts, is not merely a matter of cosmetic appearance, as people often assume. Cleft lip and palate — “one of the most common birth defects” — manifests in 35,000 new cases every year, and requires care over a number of years, with “multiple interventions by various disciplines” until the patients are 15-16 years old. Problems start early. “The newborn can’t breastfeed or swallow because communication from the nose to mouth is difficult,” he says. To work around this, mothers have to be taught to feed their children at a slightly different angle, without which the child may end up severely malnourished, as he has seen in many cases.
“Maintaining hygiene in the mouth is tough because there is no separation between the nasal and oral cavity. Then, despite the primary surgery, often, speech becomes a problem when the baby starts learning to speak. They require speech and language therapy for around 18 months to enable them to speak clearly.” That’s not all. The abnormal programming of cleft lip and palate can also leave its footprint on the jaw and teeth. So teeth may be rotated or deformed, and there will be no bone. “In such cases, bone grafting is required to enable normal tooth development. Because we are operating on their tissues when they’re very young, they may need orthognathic surgery to align the two jaws at around 15-16 years. Lastly, if they are bothered by slight nasal asymmetries, they can get rhinoplasty done.”
Today, Smile Train India has over 180 partner hospitals and 300 partner surgeons in 110 towns, with 10 partner hospitals in Karnataka (Mangalore: 3, and one each in Bengaluru, Belgaum, Davangere, Mysore, Raichur, Gulbanga and Dharwad). “In 15 years, Smile Train has provided close to 462,000 free surgeries in India. Of these, close to 7,500 surgeries are in Bengaluru, and 29,000 surgeries in Karnataka,” adds Mamta Carrol, Director, Smile Train India.
For Dr Bonanthaya, the support has meant many happy endings — like in the case of a patient whose chances of a promotion were affected because he needed to make a lot of voice and video calls. “After the primary surgery which had been done elsewhere, he was experiencing problems with speech. We did a secondary procedure and followed up with speech therapy for a year. Today he’s happy and doing well,” Dr Bonanthaya recalls.
It’s a passion for DrBonanthaya, who trained in working with facial fractures, jaw deformities, tumour removals and the like, but chose to specialise in cleft and cancer. “Then when Smile Train came into the picture, we got the resources and opportunity to treat a large number of patients with a systematic programme,” he says. He often sees patients from the time they’re a week old to once every year over the course of their treatment. That includes having a conversation using particular syllables to check their speech, working dexterously to insert endoscopes into their tiny noses to examine the working of the soft palate, and so on. The challenges are many, but “the opportunity to transform lives and have an impact on a person’s future is very fulfilling,” he admits. It keeps him going.
His patients are sometimes a week old. Parents filled with trepidation at the prospect of a surgery on their tiny wards have to be convinced that no matter how painful, it’s best if interventions are done when their children are young. As someone who has been performing cleft lip and palate surgeries for 14 years, Dr
When we meet the maxillo-facial surgeon at Bhagwan Mahaveer Jain Hospital, it is a busy afternoon, with patients and their anxious parents lining the waiting area. The procedure, he asserts, is not merely a matter of cosmetic appearance, as people often assume. Cleft lip and palate — “one of the most common birth defects” — manifests in 35,000 new cases every year, and requires care over a number of years, with “multiple interventions by various disciplines” until the patients are 15-16 years old. Problems start early. “The newborn can’t breastfeed or swallow because communication from the nose to mouth is difficult,” he says. To work around this, mothers have to be taught to feed their children at a slightly different angle, without which the child may end up severely malnourished, as he has seen in many cases.
“Maintaining hygiene in the mouth is tough because there is no separation between the nasal and oral cavity. Then, despite the primary surgery, often, speech becomes a problem when the baby starts learning to speak. They require speech and language therapy for around 18 months to enable them to speak clearly.” That’s not all. The abnormal programming of cleft lip and palate can also leave its footprint on the jaw and teeth. So teeth may be rotated or deformed, and there will be no bone. “In such cases, bone grafting is required to enable normal tooth development. Because we are operating on their tissues when they’re very young, they may need orthognathic surgery to align the two jaws at around 15-16 years. Lastly, if they are bothered by slight nasal asymmetries, they can get rhinoplasty done.”
Dr Bonanthaya and his team of orthodontists, speech and language pathologists, pediatric anesthesiologists and pediatricians have managed to improve the scenario over the years with the aid of Smile Train, a global children’s charity, which provides financial support to families. “Until Smile Train started working in India in 2000, only about 25 per cent of the children were getting treatment. When we started, the mean age for primary surgeries was 15-16. Today more than 90 per cent of the time, it’s at two years of age, which dramatically improves the outcome of the surgery,” he says. That’s important. He emphasises that a procedure called naso-alveolar moulding — which helps mould the deformed bone and flesh into more favourable positions before the primary surgery using pre-surgical orthopaedics — is important. And the earlier it’s done (ideally, two-three weeks of age), the better the outcome, both cosmetic and physiological, for the patient.
Today, Smile Train India has over 180 partner hospitals and 300 partner surgeons in 110 towns, with 10 partner hospitals in Karnataka (Mangalore: 3, and one each in Bengaluru, Belgaum, Davangere, Mysore, Raichur, Gulbanga and Dharwad). “In 15 years, Smile Train has provided close to 462,000 free surgeries in India. Of these, close to 7,500 surgeries are in Bengaluru, and 29,000 surgeries in Karnataka,” adds Mamta Carrol, Director, Smile Train India.
For Dr Bonanthaya, the support has meant many happy endings — like in the case of a patient whose chances of a promotion were affected because he needed to make a lot of voice and video calls. “After the primary surgery which had been done elsewhere, he was experiencing problems with speech. We did a secondary procedure and followed up with speech therapy for a year. Today he’s happy and doing well,” Dr Bonanthaya recalls.
It’s a passion for DrBonanthaya, who trained in working with facial fractures, jaw deformities, tumour removals and the like, but chose to specialise in cleft and cancer. “Then when Smile Train came into the picture, we got the resources and opportunity to treat a large number of patients with a systematic programme,” he says. He often sees patients from the time they’re a week old to once every year over the course of their treatment. That includes having a conversation using particular syllables to check their speech, working dexterously to insert endoscopes into their tiny noses to examine the working of the soft palate, and so on. The challenges are many, but “the opportunity to transform lives and have an impact on a person’s future is very fulfilling,” he admits. It keeps him going.
