Reply

Abstract

Sir: We thank Dr. Lowry for taking the time to read our article,1 and we appreciate his comments. Our article was first written as an Original Article. However, at the request of the Editor, it was revised as a Viewpoint article. As such, there was a significant space constraint and much of the material that was cut to fit the shorter format would have addressed the issues he mentioned. We agree that there is some confusion about the term “isolated cleft palate.” To clarify, we used the term isolated cleft palate to mean a cleft of the palate without a cleft of the lip, as is the convention in national and international database and research efforts. Isolated cleft palate can be associated with other anomalies (e.g., cardiac) and still be considered isolated cleft palate (without cleft lip). In fact, up to 40 percent of patients with cleft palate have associated anomalies, a higher rate than cleft lip and palate. Some studies try to separate syndromic from nonsyndromic; however, we made no such attempts in describing overall rates. No sources were given, as the number of references is limited in a Viewpoint article. We referenced our earlier article2 to help clarify for anyone that was interested in reviewing the original data, and Dr. Lowry correctly identified that. His concerns about the intranational and international differences in reporting data are similarly addressed in the earlier article.2 Finally, we would agree that a 5-year study may be too short to infer trends in rates. The counterpoint, though, is that data and reporting continuously improve and more recent data may be more valuable than older data. This was the original inspiration for this series of articles. As a point of correction, we reported that the U.S. rate was increasing and the international rate was stable. The data cited by Dr. Lowry would seem to support and not refute our conclusions. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Raman C. Mahabir, M.D. Texas A&M Health Science Center College of Medicine, and Division of Plastic Surgery Scott & White Healthcare Temple, Texas Shoichiro A. Tanaka, B.S., M.P.H. Texas A&M Health Science Center College of Medicine Temple, Texas Daniel C. Jupiter, Ph.D. Texas A&M Health Science Center College of Medicine, and Department of Surgery Scott & White Healthcare Temple, Texas John M. Menezes, M.D. Division of Plastic Surgery University of Nevada School of Medicine Las Vegas, Nev.