The who done the primary surgery, which is

The management of cleft lip & palate (CLP) patients is undertaken by a number of surgical specialities, such as Oral & Maxillofacial Surgery, Plastic Surgery, ENT and also general surgery. Asher & Shaw 1990, in their study regarding the current cleft lip and palate management in the United Kingdom (UK) shows that a total of 45 cleft team working in England, Wales, Scotland and North Ireland. A total of 676 new cleft patients were seen per year, with each surgeon having an average case load of 10.2 patients per year. For the combine cleft clinic, it mostly involved only the plastic surgeon, orthodontist and speech therapy. Only few centres that include others team, such as ENT surgeon, maxillofacial surgeon and the audiologist. Other than that, for the timing of surgery, 90.2% lip closure done at the age 3 months, and 56.4% palatal closure done at the age of 9 to 12 months. Majority of the operation done by the plastic surgeon   

Another study by Williams et al in 1995 was done to investigate the delivery of surgical cleft care in the UK. From this study, they found 57 cleft teams (75 surgeons from different specialities: oral & maxillofacial, plastic, paediatric & ENT surgeon) were identified operating in that year, with an average of 23.5 new referrals CLP patient per year. Only 48 surgeons did the lip repair with an average 9.1 patient, meanwhile 50 surgeons did the palate repair with an average 13.2 patient and for the ABG procedure, all surgeons involved with an average 7 patient per surgeon per year.

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 Brennan et al, 2001 specifically conducted a study regarding management of CLP patients by Consultant Oral & Maxillofacial Surgeon. Out of 191 surgeons, only 73 or 38% involved in cleft surgery and 75% (55 surgeons) regularly attended the CCC. There are only a small number of the consultant who done the primary surgery, which is the cleft lip & palate repair. Only 7 surgeons involve with the average of 3 to 22 lip repairs and 2 to 18 palate repairs cases in the study year. This means, during that time most of the cleft & palate repair done by the plastic surgeon. Whereby, most of alveolar bone graft (ABG) procedure, 79% contribute by the by the oral surgeons (58 surgeons).  Scott et al, 2014 in their recent study on a cross-sectional survey regarding the centralization of services for children born with orofacial cleft in the UK, there are 11 cleft services and MDT approach is applied for the management patient with CLP. Orthodontics and primary cleft surgery was the only specialities that represented in all cleft services. Most of the time, MDT clinic attend by the primary surgeon and speech & language therapy. The attendance for CCC by the secondary cleft surgeon only attends about 58% and paediatricians 18% only. Most of the referral cases are babies (birth to 1 year old) contribute 55%, followed by children, 37% (1year old to 18 years old) and adults, 8% (age above 18 years old). There are about 19 primary surgeons with an average of 78 children underwent an operation. This number is far away from the recommendations by CSAG 1998, which is 40-50 cases per year by 1 primary surgeon. All of the cleft team also actively involved in the audit and research programs, which is good in order to improve the quality and the effectiveness of the cleft team itself.

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