Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7133 Volume 316 News Saturday 7 March 1998 Unpalatable results force cleft surgeons to rethink A damning report on cleft lip and palate repair has forced British surgeons to confront a longstanding disagreement over which specialty should carry out the technically challenging surgery. After investigating 297 children aged 5 and 277 aged 12 who had all undergone cleft repair in Britain, the Clinical Standards Advisory Group found that two out of five had poor dental bite, less than a third had a good lip appearance at age 12, and under half could speak with normal intelligibility at that age. Results for cleft lip and palate repair are poor SIPA/REX FEATURES The group's committee said that of the 57 units currently carrying out cleft palate repair, only six to eight provided good to excellent care and the overall results were five to 12 times poorer than in the six European centres examined. Competition between plastic and maxillofacial surgeons was a key factor in these results, the committee noted, causing poor training and low volume operating. The report states that it is imperative for the good of children with a cleft lip and palate that "the specialties involved agree to delineate the areas of expertise and to designate certain supra-specialists." Most surgeons doing cleft repair do only one or two such operations a year. However, the Clinical Standards Advisory Group recommends reducing the number of centres where such operations are performed to between 8 and 15 nationally, each with two surgeons doing at least 40-50 new cases a year. Representatives of the two surgical specialties met last week to start trying to resolve their differences. However, the gulf is clearly a wide one. Mr John Williams, dean of the faculty of dental surgery and a member of the working party that produced the report, said that the discoveries were "appalling" and were the result of inadequate experience: "Cleft palate is part of training requirements for plastic surgeons. This is quite clearly wrong as it's the only operation they do on the mouth. So when they do one, their expertise is less than adequate." But another member of the working party, Professor Roy Sanders, past president of the British Association of Plastic Surgeons, said: "We've been operating on lips and palates and reconstructing tongues for years. It is plastic surgery that has developed all the processes of reconstruction." Limited record keeping - also noted as a failing in the report - meant that comparison between the two specialties could be drawn only in alveolar bone grafting. Here 50% of cases carried out by plastic surgeons failed or were seriously deficient, compared with 32% of those done by maxillofacial surgeons. Professor Sanders said that what is most important is not which discipline did the work, but the level of training and experience. He added that the suggested reduction in units carrying out cleft repair was too severe: "You would have one unit serving around 5 million people. Inaccessibility is a huge problem if you concentrate services like this." The Clinical Standards Advisory Group's report, Cleft lip and/or palate, is available from HMSO bookshops, price £15. Hilary Bower London Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline