Cleft Lip & Palate Team at Greater Baltimore Medical Center: Fixing Gaps, Exposing Rifts

By Karen Buckelew

The Cleft Lip & Palate Team at Greater Baltimore Medical Center was established to mend gaps – specifically, to heal the splits or holes in babies’ lips or mouths that can lead to ugly deformities, feeding issues and speech problems.

At the same time, it seems the multidisciplinary team of experts has exposed a rift in the medical community, one that pits large hospitals against smaller institutions and one physician specialty against another.

At the center of the issue is the roughly one in 1,000 babies born with cleft lips or cleft palates – or both, said Dr. Randolph B. Capone, director of The Baltimore Center for Facial Plastic Surgery.

In 2003, Capone helped to found the Towson hospital’s cleft lip/ palate treatment team, which includes experts in 16 subspecialties including genetics, speech pathology, oral surgery, otolaryngology and dentistry.

Capone, an ear, nose and throat specialist as well as a facial plastic surgeon, said infants born with cleft lips and cleft palates at GBMC used to be diverted to large academic medical centers such as Johns Hopkins Hospital or the University of Maryland Medical Center.

The Towson hospital is a leader in births in the region – 22,000 in the past five years – and it wanted to serve its own cleft lip and palate babies, Capone said.

The team has seen 74 patients since its first baby in 2004, and has performed 30 surgeries.

Capone’s work with the team last month won him the American Medical Association’s 2007 Young Physician Community Service Award, an honor established in 1994 to raise awareness of the work doctors perform in the community.

“This is the most rewarding work we do by far,” said Capone, who performs other types of cosmetic and reconstructive surgeries as well.

But the work of Capone and his team raises the question of who should be performing such procedures, and at which hospitals, said Dr. Ronald P. Silverman, chief of the division of plastic surgery at the University of Maryland Medical Center and co-director of the hospital’s Earl and Frances Clem Cleft Lip and Palate Program.

Silverman noted that Capone is certified by the American Academy of Facial Plastic & Reconstructive Surgery, a group consisting mostly of doctors also board-certified as ear, nose and throat specialists.

Silverman is certified by the American Board of Plastic Surgery.

Facial plastic surgeons such as Capone have been competing for patients with surgeons certified by the traditional plastic surgery board, according to Silverman.

“That is something plastic surgeons like myself are very unhappy about,” Silverman said.

Said Capone: “There’s some semblance of a turf battle. I think the traditional lines that define our specialties are totally blurring. As far as the patient, they need to know the physician is board certified in an appropriate specialty.”

Silverman, whose center sees as many as 120 patients annually, said he doesn’t begrudge GBMC or its program.

“I don’t fault anybody who’s good who wants to do this,” he said.

The payoff for patients and their families can be great, said York, Pa., resident Jennifer J. McGurn. Her son, Kevin, was born with a cleft palate at GBMC in April 2004.

Jennifer McGurn’s younger brother was born with a cleft lip and a cleft palate, so when a nurse told her Kevin had a small hole in the roof of his mouth, she was perhaps more prepared than most mothers.

But then, she recalled, “I got home and he wasn’t gaining weight and was facing surgeries. [The GBMC team members] were amazing, especially Dr. Capone. He is just very relaxed and he really puts you at ease.”

That’s the team’s very purpose, according to Capone.

“This is not a moneymaker,” he said. “The motivation is to take care of the community.”

(c) 2007 The Daily Record (Baltimore). Provided by ProQuest Information and Learning. All rights Reserved.