International Physician Update

Saving Face: Patrick Byrne's Work for Children

Patrick Byrne examines Nicolas Hampshire's ear, which Byrne reconstructed. Byrne travels worldwide to rebuild ears, noses and cleft palates.

Facial plastic and reconstructive surgeon Patrick Byrne will never forget the Vietnamese family who came running after him last October. Byrne was in Ho Chi Minh City (formerly Saigon) to teach a course on rhinoplasty through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), as part of its Face to Face committee.

The family arrived late for clinic because of traffic and was afraid Byrne would refuse to operate on their 20-year-old daughter. She had a severe cleft palate and facial deformity, one of the worst cleft nasal deformities he’d ever seen. But despite having filled the OR schedule with almost 40 surgeries, Byrne could not turn this family down.
The surgery took five hours. Byrne used a bone graft from the hip and ear cartilage to restructure the girl’s face.

It was the highlight of his trip—the young woman is doing well, and the family couldn’t be more grateful. “You get a more balanced perspective when you travel to cultures where facial reconstruction is not just a matter of nips and tucks. Many of these people have disfiguring abnormalities and often can’t afford to have them corrected,” says Byrne, director of the Division of Facial Plastic and Reconstructive Surgery in the Department of Otolaryngology-Head and Neck Surgery at Hopkins.

AAFPRS’s Face to Face committee sends doctors to foreign countries to educate local surgeons and to provide pro bono care. Four surgeons accompanied Byrne to teach Vietnamese doctors and nurses about rhinoplasty and other facial surgeries.

In all, the conference drew 217 participants, filling lecture halls to capacity. They used four ORs, with live video-feed and interpreters. “Their thirst for the latest techniques made it especially worthwhile,” Byrne says.

Cleft palate strikes one in 600 people, but Southeast Asia likely has a higher incidence. Fixing it is not just cosmetic, Byrne says.

Uncorrected, the opening in the roof of the mouth can have a devastating effect on speech. It can also affect breathing and digestion. In the United States, cleft palates are usually corrected approximately one year after birth. Cleft lip is repaired early, about one month after birth. If not done early, it may still be performed with great benefit later on. If surgery is delayed too many years, the effects on speech development are devastating and sometimes irreparable. Facial growth ends for boys by age 17 and for girls at age 15.

While in Vietnam, Byrne also performed skin grafts on burn victims. Burns are common in Asian countries and many developing countries, Byrne says, perhaps because of the way food is prepared there—the combination of oil and high heat poses an increased risk.
 Since 1990, Byrne has traveled to China, Mexico and Africa on similar missions.

His next stop is Ecuador, where he’ll serve as medical director for Ecuadent, a nonprofit medical and surgical team that treats kids with facial deformities. He’s also venturing into the field of art as applied to medicine. Melding surgery, art and technology, Byrne is developing surgical approaches that are both creative and beneficial for the growing list of patients who need his help.