Dr Felicity Mehendale

Felicity MehendaleConsultant Cleft & Plastic Surgeon,
Clinical Lead East of Scotland Cleft Lip and Palate Service,
Honorary Senior Clinical Lecturer
Email: felicity.mehendale@nhslothian.scot.nhs.uk
Cleft Lip and Palate Service, Royal Hospital for Sick Children, Edinburgh, EH9 1LF
Telephone : +44 (0)131 536 0976  Fax: +44 (0)131 536 0852
PA’s contact details: Zoe Sharp, +44 (0)131 536 0976

Summary of Research:

Velopharyngeal Function
We have developed new ways of evaluating the function of the velopharyngeal valve that is critically important for normal speech as well as breathing. These tests help to determine the best way to treat patients with speech problems, while maintaining a good upper airway.

Further studies of the aerodynamics of velopharyngeal function are now possible following funding from Sick Kids Friends Foundation to purchase PERCI-SARS. This will also allows us to study the timing of velopharyngeal closure with accuracy that had not been possible previously. We also plan studies using biofeed back and better evaluation of velopharyngeal coordination problems.

Various studies in collaboration with specialist cleft speech and language therapists, ENT surgeons, respiratory paediatricians, sleep physiologists

Pierre Robin sequence (PRS)
This is one of the most common conditions we treat. It causes upper airway obstruction in babies with cleft palates and can be life threatening. Optimising the upper airway in these babies with multidisciplinary team management is essential. Completed and ongoing studies have focussed on early airway management, oral feeding, timing of surgery, early postoperative outcomes and epidemiology of PRS in collaboration with specialist cleft speech and language therapists, ENT surgeons, respiratory paediatricians, sleep physiologists and cleft clinical nurse specialists. Planned future studies include longer term cognitive outcomes.

Anatomical studies

  • Various anatomical studies in collaboration with Simon Parsons including MSc projects on Anatomy of the lesser palatine nerves – J Mortimer
  • Anatomy of the posterior pharyngeal wall with regard to posterior pharyngeal wall augmentation for VPI – N Zubia
  • Anatomical study of the genioglossus – V Chatain

3D imaging of the face
2D photographs have  a number of limitations in quantifying facial anatomy, symmetry and surgical outcomes. We collect longitudinal 3D photographs on all our patients who undergo cleft surgery, commencing at 3-4 months old, prior to their lip repair.

In collaboration with Prof Ayoub’s group in the University of Glasgow, we are analysing these data and have offered a PhD studentship.

In collaboration with Prof Ayoub’s group, we have applied for funding to carry out 4D facial imaging studies in older children with cleft.

Cleft outcome studies
In collaboration with cleft colleagues across the UK we study a range of outcomes from cleft treatment. Our team has contributed to the development of standards and protocols for data collection and analysis in a standardised manner across the UK. All data are collected and evaluated according to UK protocols designed to minimise bias and enable independent objective outcome assessment. Outcomes studied in 5 year old patients include speech following cleft palate repair, jaw growth following UCLP (unilateral cleft lip repair), dental health and audiology.  Our unit is also trying to identify early predictors of longer term outcomes.

The East of Scotland Cleft Service is also involved in national and international studies:

  • TOPS – an international RCT on the timing of palate repair
  • Cleft Care UK
  • The Cleft Collective Birth Cohort Study

Publications

  • Transcleft approach to choanal atresia. A new techinique. K Medjoub, M Montague, Mehendale FV. – in submission 2013, to Cleft Palate Craniofac.J
  • A novel patient controlled bi-directional palatal lift appliance. L. Greene, K. Wilson, G. McIntyre, J. Wilson, F. Mehendale – submitted 2013, to Cleft Palate Craniofac.J
  • Effect of palate re-repairs and hynes pharyngoplasties on pediatric airways: an analysis of preoperative and postoperative cardiorespiratory sleep studies. Mehendale, F. V., R. Lane, A. Laverty, R. Dinwiddie and B. C. Sommerlad (2013). Cleft Palate Craniofac J 50(3): 257-267.
  • Mehendale FV. Surgical Anatomy of the levator veli palatini – a previously undescribed tendinous insertion of the anterolateral fibres. Plast Reconst Surg 2004 Aug;114(2):307-15.
  • Mehendale FV and Sommerlad BC. Surgical significance of abnormal internal carotid arteries in velocardiofacial syndrome in 43 consecutive Hynes pharyngoplasties. Cleft Palate Craniofac.J 2004 Jul;41(4):368-74.
  • Mehendale FV, Birch M, Sell D, Birkett L, and Sommerlad BC Surgical management of velopharyngeal incompetence in velocardiofacial syndrome. Cleft Palate Craniofac.J 2004 Mar;41(2):124-35.
  • Mehendale FV, Sommerlad BC Submucous cleft palates presenting with a perforation. Letters to the editor. Cleft Palate Craniofac J 2004;41: 107-108
  • Mehendale FV and Sommerlad BC Unilateral Moore pharyngoplasty in the treatment of asymmetric velopharyngeal incompetence. Cleft Palate Craniofac.J 2003;40: 263-268
  • Mehendale FV and Sommerlad BC Submucous cleft palates presenting with a perforation. Cleft Palate Craniofac.J 2003;40 (2):203-206.
  • Sommerlad BC, Mehendale FV, Sell D, Birch MJ, Hattee C, and Harland K Letter to the editor – Palate re-repair revisited. Cleft Palate Craniofac.J 2003;40 (1):108.
  • Mehendale FV and  Shailendra A Could this be a simple pressure sore? Rapid Responses to Minerva BMJ 2003; 326: 890
  • Mehendale FV and Sommerlad BC Gross unilateral abnormalities of the velum and pharynx. Cleft Palate Craniofac.J 2002;39:461-468.
  • Mehendale FV and Sommerlad BC Airway obstruction due to rudimentary premaxillae in holoprosencephaly. Cleft Palate Craniofac.J. 2001;38 (3):271-282.
  • Sommerlad BC, Mehendale FV, Birch M, Sell D, Hattee C, and Harland K Palate re-repair revisited. Cleft Palate Craniofac.J 2002;39:295-307.
  • Sommerlad BC and Mehendale FV A modified gag for cleft palate repair. Br.J Plast.Surg 2000;53 (1):63-64.
  • Mehendale FV and Sommerlad BC Paraffinoma – a complication of Jelonet packs following rhinoplasty. Br.J.Plast.Surg. 2001;54 (2):179-180.
  • Mehendale FV, Taams KO, and Kingsnorth AN. Repair of a giant inguinoscrotal hernia. Br.J Plast.Surg. 2000;53 (6):525-529.
  • Mehendale F and Martin P The cellular and molecular events of wound healing. In: Falanga V, ed. Cutaneous Wound Healing. 2001 Martin Dunitz
  • Mehendale FV. Conservative Breast Surgery for Carcinoma of the Breast – Dissertation for M.S.(General Surgery)  degree. Tata Memorial Hospital and Tata Memorial Cancer Centre, University of Bombay, India, 1991

Current sources of Funding

  • Timing of Primary Surgery for Cleft Palate (TOPS) (PI for East of Scotland) R&D No: 2012/C/PSU/01 – An international RCT on timing of palate surgery. NIH funded international trial.
  • Cleft Care UK Study – (PI for East of Scotland) R&D No: 2011/C/DEN/01 NIHR , University of Bristol.
  • Cleft Collective Birth Cohort Study (PI for East of Scotland) study run by University of Bristol. Funder – The Healing Foundation

Previous Sources of Funding

Royal College of Surgeons
Surgical Research Fellowship (2003 – 2004) – part funding for a PhD on velopharyngeal anatomy and function.

The Craniofacial Society of Great Britain and Ireland
Project grant – Working with medical physicists, computer scientists, and radiographers, I developed a new technique for measuring 3-dimensional parameters of dental models in unilateral cleft lip and palate (UCLP) patients, using CT scanning.

The Wellcome Trust
Wellcome Clinical Training Fellowship (1998 – 1999) – to study embryonic wound healing with Dr Paul Martin in the department of Anatomy and Developmental Biology, University College London.
I carried out surgery on 14 day old mice embryos to study how they heal wounds in order to improve how human wounds heal.

Qualifications / Degrees

  • F.R.C.S. (Plastic Surgery) Intercollegiate Board of Plastic Surgery (Sept 1997)
  • EBOPRAS Diplomate of the European Board of Plastic, Reconstructive and Aesthetic Surgery (Nov 1997)
  • F.R.C.S. Royal College of Surgeons of England (Oct 1992)
  • M.S. (General Surgery) Tata Memorial Cancer Centre, University of Bombay, India  (Jan 1991)
  • M.B.B.S. Grant Medical College, University of Bombay, India (Oct 1986)

Selected research and academic prizes

Felicity Mehendale is the only person to have been awarded the Craniofacial Society of Great Britain and Ireland Arnold Huddart Medal twice.

Arnold Huddart Medal Craniofacial Society of Great Britain and Ireland, Dublin 2001 for developing a new technique of measuring casts of babies mouths with clefts and showing that hypoplasia of the lesser segment was associated with poor growth of the maxilla.

Arnold Huddart Medal Craniofacial Society of Great Britain and Ireland, Reading 2000. For research describing a previously undiscovered finding in the human levator veli palatini.

Ian McGregor Medal  F.R.C.S. (Plastic Surgery) 1997

Hallett Prize Primary F.R.C.S. – Royal College of Surgeons of England, 1991

Recent Prizes awarded to students and junior doctors who were supervised by Dr Felicity Mehendale:

Arnold Huddart Medal – awarded to J Mortimer.
Radical dissection and retropositioning of the velar muscles for cleft palate repair – what about the lesser palatine nerves? – J Mortimer, FVMehendale, S Parsons. Craniofacial Society of Great Britain and Ireland, April 2013

Harold Ellis Prize for anatomy research papers  – awarded to J Mortimer.
An Anatomical Study of the Lesser Palatine nerves – J Mortimer, FVMehendale, S Parsons. 2013

Healing Foundation Prize for the best poster – awarded to L Greene.
A novel patient controlled bi-directional palatal lift appliance. L. Greene, K. Wilson, G. McIntyre,
J. Wilson, F. Mehendale Craniofacial Society of Great Britain and Ireland, April, 2012

Committees Served

  • Healing Foundation Research Council – representing the Craniofacial Society of Great Britain
    & Ireland
  • National Institute for Health Research (NIHR, MCRN) Cleft and Craniofacial Studies Group
  • Surgical Specialities Subcommittee of the British Medical Association 2011 to present
  • Council member Royal Society of Medicine, Comparative Medicine Council
  • SIGN Council – representing the Royal College of Surgeons of England
  • Beyond Eurocleft – This international task force was established to make recommendations for initiation of and participation in multi-national cleft outcome studies
  • American Cleft Palate Association Task Force to share good practice and experience internationally and to promote international collaboration
  • Scottish Oral Health Research Group – a group of researchers from the Universities of Edinburgh, Glasgow, Dundee and Aberdeen, to collaborate on oral health research

Selected  Invited lectures

The Burden of Care – Medicine and Me meeting on Cleft Lip and Palate – Royal Society of Medicine. London, July 2013

“Clinical Outcomes… Best Practices? Surgical Perspectives in Research”. International Congress on Cleft Palate and Craniofacial Anomalies, Florida,  May 2013

“Investigation and treatment for VPI” Speech and Language Therapists Scottish meeting. December 2012

“VPI Surgery and the Airway”. Global Aspects of VPI; Symposium organised by the American Cleft Palate Craniofacial Association, San Jose, April 2012

“Quality of Life Outcomes from a VPI Perspective”. Global Aspects of VPI; Symposium organised by the American Cleft Palate Craniofacial Association, San Jose, April 2012

A Protocol for the Management of Velopharyngeal Incompetence. 69th Annual Meeting American Cleft Palate-Craniofacial Association, San Jose, April 2012

Maximising benefits while minimising burdens – the approach to the palate in the face of a 22q11.2 deletion. 62nd Annual meeting and preconference symposium, American Cleft Palate Craniofacial Association, April 2005

International debate on the extent of muscle dissection in cleft palate repair. Indian Society of Cleft Lip, Palate & Craniofacial Anomalies, 4th Annual Meeting, Hyderabad, India, Jan 2005

Cleft Lip and Palate Surgery – The Coal Face and the Future. Royal Society of Medicine, London, November 2004.

Results of surgery for VPI in velocardiofacial syndrome. A workshop for cleft lip and palate teams. Institute of Child Health / Great Ormond Street. October 2004

Evidence for the importance of a radical muscle dissection in cleft palate repair.  2nd Annual Meeting and International Update – Indian Society of Cleft Lip, Palate & Craniofacial Anomalies. Chennai, India, March 2003

Decision making in velopharyngeal incompetence (VPI) management. 2nd Annual Meeting and International Update – Indian Society of Cleft Lip, Palate & Craniofacial Anomalies. Chennai, India, March 2003

Public Engagement Activities

I hugely enjoy communicating medical science

Invited speaker at the Cheltenham Science Festival

  • Regenerative Medicine – where will we be in 50 years time (June 2013)
  • Playing God – Risk in Surgery (June 2009)
  • Facing Disfigurement (June 2009)
  • Best of the Fest (June 2009)
  • Interview on BBC Radio Scotland, Medical Matters – Wound healing and scarring
  • Invited talks to parent / patient associations such as the Cleft Lip and Palate Association (CLAPA) and Velocardiofacial Syndrome Educational Foundation (VCFSEF)
  • Invited talk on Velopharyngeal function and Airway for the Max Appeal conference, Edinburgh, June 2011
  • Judge for Debating Matters Competition

Future Events

International Congress on Cleft Palate and Craniofacial Anomalies, Edinburgh 2021
We won the bid to host this 4 yearly congress in Edinburgh and bring it to the UK for the first time.

Positions Available

A variety of projects for MSc, PhD and SSM medical students, please email me or contact Zoe Sharp on +44 (0)131 536 0976.

Page last updated on 17 July 2013