Evolving consensus in cleft care: Reply to letter to the editor

Abstract

Sir, The scenario of cleft care in India is rapidly changing and has taken rapid strides forward in the last decade or so. Thanks to the role of many NGOs who have come forward to fund free cleft care for the children suffering from this affliction in the developing world. However, controversies abound in this field as far as cleft protocols, timing, and effectiveness of various procedures are concerned. This is true not only in the developing world but in the western world too where societies and organizations are trying to find common ground to recommend or refute definite timelines or procedures to the surgeons performing cleft surgeries. It is in this context that the Indian Society of Cleft Lip Palate and Craniofacial Anomalies (ISCLPCA) sought to flesh out a “Consensus in Cleft Care” and recommend the same (timelines and procedures) to the surgeons performing cleft surgeries in India. The panels which discussed the various issues in cleft care sought to temper the “ideal” with a practical knowledge of the ground realities in India and thus, recommend a protocol which, while being targeted toward delivering world class results, were practical enough to be easily followed by various cleft centers across our country. The recommendations took hours of deliberations and personal communications and some work, thereafter, before they could see the light of the day and be accepted for print in the official organ of the ISCLPCA. It is unfortunate that some typographical errors inadvertently crept into the manuscript and also as commented upon by my colleague in the previous letter, escaped the careful eye of authors, reviewers, and the editorial board. The mistakes have hence been promptly rectified in the online version of the article. The authors sincerely regret this unfortunate slip-up and hope that this would not distract the attention of the reader from the important message that the article carries. Another issue that my colleague has touched upon is the recommendation for the timing of the cleft lip surgery. However, the authors wish to remind the readers that this is the considered recommendation of the panel regarding the preferred age of lip repair and does not stop any person from operating upon a patient if he or she turns up late for lip repair. Furthermore, it has been noted by various authors that cleft surgeons in various centers across India catering to cleft patients are already operating the lip at 3-6 months of age [1] and that the percentage of patients presenting before 1 year of age is nearly 15% [2] and almost 43.62% of children are operated before 2 years of age. [3] This is amazing statistics compared to a decade ago when the proportion of children to adults was much less than it is today. Most smile train centers today are seeing a perceptible fall in the mean age of children reporting for cleft surgery. Thanks to the aggressive outreach programs of these centers and the various information campaigns that these centers run (Khanna V. 2013. Personal communication). Keeping this very encouraging trend in mind, the panelists have no hesitation in recommending the preferred age of lip repair in India (permeated as it is by centers running various charity programs funding cleft care) as between 3 and 6 months of age. It was our sincere hope that the recommendations would bring uniformity in cleft care across India and stimulate better results and better research.