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Specialised multidisciplinary team can solve problems of distance

1995; BMJ; Volume: 311; Issue: 7017 Linguagem: Inglês

10.1136/bmj.311.7017.1431b

0959-8138

A. Cabre, K. P. Gibbin, Mark Henley, R. N Nashed,

Global Health and Surgery

Editorial proves controversialED1ToR,-In their two year Medline search for studies on the results of cleft surgery Tony Markus and Peter Ward Booth found just one British study, and they criticise the lack of British studies.'Six studies on primary and secondary surgery and outcome analysis are noteworthy,2-7 as is a book on speech.8Citing just the Eurocleft study, which included two British centres, Markus and Ward Booth state that British results are poor.This is not true in other British studies.910The authors neglect to mention that the two centres with the best results in the Eurocleft study used different surgical techniques (none like Markus's) and high volume operators (none of them maxillofacial surgeons).On high volume operators Markus and Ward Booth are incoherent.They move from implying that specialist high volume operators are preferable to stating that high volume operators and large, centralised units do not guarantee good results, while high volume maxillofacial surgery exists in district hospitals, which are well placed to provide a comprehensive service.European countries, including Britain, have made advances in cleft surgery."Continental Europe may do it better"'-or it may not.Early cleft bone grafting was once strongly advocated in Germany, but further studies in, for example, Britain and Germany led to its being abandoned."For years the technique of delayed hard palate closure of Schweckendiek in Germany was considered to be good, until it was reported to give poor results in terms of speech.'2Other studiesfor example, one in Britain-had earlier shown worse speech after delayed hard palate closure.'2Two French cleft surgeons, Malek and Delaire, are known internationally.Delaire never kept detailed records and did not publish his results.Nevertheless, Markus uses Delaire's technique and states that it "results in better function and more normal growth and development."'There is no evidence for this in the references given.Markus labels his surgery functional surgery, as