NZ plastic surgeons lead study

By REBECCA WALSH

New Zealand plastic surgeons are leading an international study to work out the optimum age for operating on children with cleft lip and palate.

The study, initiated by Dr Adrian Skinner, a plastic surgery registrar at Middlemore Hospital, will look at a range of outcomes for children who had the surgery 10 years ago.

Dr Skinner said that although the same technique was generally used around the world to try to correct cleft lip and palate, children in different countries were operated on at different ages resulting in varied outcomes.

New Zealand children received the final stage of the surgery when they were 9-12 months old whereas in Canada surgery was done as late as two years old.

That meant New Zealand children had an advantage in terms of hearing and speech but their faces sometimes appeared flattened and their jaws jutted out.

In Canada the practice was to wait to allow the face bones to grow more "at the probable disadvantage of hearing and speech".

About one in 500 children are born with a cleft lip and palate, where there is a split in the upper lip and a gap in the roof of the mouth that separates the mouth from the nasal cavity.

Apart from a distinctive physical appearance, they can have hearing and speech difficulties.

The study proposal outlines a set of protocols for assessing surgery results 10 years after surgery. Among checks would be a speech language assessment, a hearing test, orthodontic checks and x-rays of the head.

John Meara, director of the department of plastic and maxillofacial surgery at Melbourne's Royal Children's Hospital, supported the research, saying it could be used to help surgeons provide the best care to patients and ensure precious health dollars were targeted in the best way.

Dr Meara said care for children with cleft lip and palate went on for years and involved a number of specialists from orthodontists to psychologists and speech language therapists.

"Some good quality outcome studies might dramatically change the way we treat cleft [lip and palate]. I think the money spent in assessing will translate into decreased unnecessary surgery, better outcomes, better health care quality and a better quality of life."

Cleft palate

* About one in 500 children is born with a cleft lip and palate, where there is a split in the upper lip and a gap in the roof of the mouth that separates the mouth from the nasal cavity.

* Apart from a distinctive physical appearance, they can suffer difficulties with their hearing and speech.