Many countries have made an effort to study the trend, protocols and outcome of management
of cleft lip and palate in their individual country. This study is on similar line
to study the trend and protocols for the management of cleft lip and palate in Egypt.
While I appreciate the author's efforts, there are, however, shortcomings of this
study: (1) only plastic surgeons have participated rather than surgeons from all specialties
who do cleft surgeries and (2) epidemiology details about cleft lip and palate prevalence
and incidence in Egypt, and how many of them able to reach for the treatment is needed
to put this article in proper context.
As per the outcome of this study, there are definitely certain areas, which demand
appropriate attentions, change of protocol and addition of skills to the cleft team.
The popularity of primary gingivoperiosteoplasty with primary cleft lip repair shows
that nasoalveolar moulding (NAM)/infant orthopaedics is being widely popular and practiced.
There are two issues here: one is NAM/infant orthopaedics is an additional labour
incentive intervention which has not shown any long-term better outcome in nasolabial
aesthetics or maxillary growth[[1]
[2]
[3]] and any team using this cumbersome procedure needs to think about the long-term
benefits and burden of care before implementing, especially with limited resource
availability.[[4]] A good surgeon with skilled hands can certainly avoid the need of NAM. Second,
primary gingivoperiosteoplasty should not be done as it has proved to have disastrous
effect on maxillary growth, and majority of centres across the world have stopped
this procedure.[[5]] The another glaring issue is two-flap push-back procedure is being still done by
56.3% surgeon, in spite of multiple studies showing very poor growth outcome following
this technique.
The present study shows very general trend but helps to bring out some ground reality
of high rate of fistula. In addition to this, a less number of patients receive alveolar
bone grafting and velopharyngeal insufficiency correction. The National Cleft Association
can take clue from these data to start discussing important issues to improve the
outcome of cleft management and avoiding or reducing the unnecessary intervention
like NAM which has more adverse effect and beneficial.
Similar studies are important, especially in countries with limited recourses to form
guideline to provide the best outcome without increasing the burden of care keeping
sensitivity to the local culture and aspiration. Such studies also provide the information
regarding the probable problems faced by the professionals across the country or some
specific part of the country.
Cleft lip and palate is one of the reconstructive surgeries that have achieved significant
attentions not only from medical professionals but also from society as large due
to it visibility, treatability and affecting children. Approximately 60%–70% of children
are being treated either by government, insurances or non-government organisations
(NGOs).[[6]] When the management is supported by any of the organisations, it is obvious that
scrutiny of the outcome of management is expected sooner than later.
In India, over the time the cleft management is concentrated in cleft centre which
has morphed/forced to be due to the support of NGOs creating centres with large number
of cleft surgeries. Many NGOs are also supporting additional services such as speech
and dental in addition to surgical care. It will be very informative to bring out
detailed study regarding the protocol and outcome of the management of cleft lip and
palate from various centres in India.
