Letters

Report on cleft lip and palate surgery

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7142.1461 (Published 09 May 1998) Cite this as: BMJ 1998;316:1461

UK results could soon surpass those elsewhere

  1. B D G Morgan, Consultant plastic and reconstructive surgeon
  1. University College Hospital, London WC1E 6AU
  2. CSAG Cleft Lip and Palate Research Team, Department of Child Dental Health, University of Bristol Dental Hospital, Bristol BR1 2LY
  3. Middlesbrough General Hospital, Middlesbrough, Cleveland TS5 5AZ
  4. Cleft Lip and Palate Association, London SW1W 9SA

    EDITOR—As a plastic surgeon I welcome the report by the cleft lip and palate committee of the Clinical Standards Advisory Group.1 However, in her news article Bower and (in his comments) the dean of the faculty of dental surgery, Mr John Williams, have got it all wrong.2 The report is not about a confrontation over who should do cleft lip and palate surgery but about what is best for a baby, child, adolescent, and adult unfortunate enough to have been born with these deformities.

    The report says clearly that what is best is a team with a full range of clinical skills that manage the patient for 20 years. The team consists of a plastic surgeon, oral and maxillofacial surgeon, nurses, speech therapist, orthodontist, and paediatrician, all properly trained and with agreed training pathways. If one accepts that the more operations you do the better you are then the report is correct in recommending a reduction in the number of teams to treat the 700 new cases a year. The disadvantage of this aim is the difficulty for parents and children travelling to the clinics in both rural and urban communities, as pointed out by Professor Roy Sanders.2 The report emphasises the need for records and proper audit over 20 years as it often takes that long for the outcome to be judged. There will be an implementation group to advise on the precise number and distribution of the teams and the need for comparative audit between the teams after a period of five years.

    I must set the record right: the comparison of results in the report is between the average of the best and worst centres in the United Kingdom against the acknowledged four best centres on the continent. The results of secondary alveolar bone …

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