Surgical Variation Between Consultant Surgeons Performing a Sommerlad Radical Intravelar Veloplasty

Abstract

Background: Although cleft surgeons in the United Kingdom follow a similar training pathway, and cleft centers adhere to similar protocols regarding timing of palate surgery and surgical technique, speech outcomes still vary significantly between centers. Objective: To explore if differences in technique exist between individual surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP). Design: An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP for primary cleft palate repair and to discuss what was important in the adoption, adaptation, and evolution of this technique within their own practice. Method: A semistructured interview schedule was designed. Interviews were conducted in person or via videoconferencing, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis. Results: Fourteen cleft consultants from the United Kingdom participated (3 females and 11 males). Seven of the consultants were trained in plastic surgery and 4 in oral and maxillofacial surgery. Eight themes were identified from the thematic analysis. One theme—Surgical Variation—is discussed. Conclusions: The findings provide insight into areas of variation seen within one surgical technique of cleft palate repair. These variations may have arisen to accommodate heterogeneity in the patient population or may have evolved in relation to different experiences of training or influences of colleagues. Further work is needed to explore the reasons for these differences in technique and to identify if any of these subtle differences contributed to variability in outcomes.

Evolution of Cleft Lip and Palate Surgical Training in the UK: A Qualitative Study

“…The first paper from this thematic analysis found that there are many surgical variations within what is ultimately recorded as one single technique. 18 This second paper suggests that differences in training experience may account for some of these variations.…”

“…Influence of the trainer may be an important factor in the development of technique as participants have previously reported that technique developed in response to those they were exposed to. 18 This paper also highlights that chosen palate repair technique is very much based on who trained you and the available literature. For example, procedures such as Furlow's palatoplasty, performed in greater numbers internationally were just not seen as often in the UK and participants technique was based on what they had the most experience of doing.…”

“…16,17 The current study was conducted as part of a broader program of work to examine variations in surgical techniques of cleft palate repair. 18 The aim of this article is to explore the training experiences of consultant CL/P surgeons and their approach to teaching others.…”

Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate

“…Although we have not explored the potential impact of different surgical techniques, experience, or timing of surgery within this paper, evidence suggests that the majority of surgeons in England, Wales, and Northern Ireland utilize a Sommerlad intravelar veloplasty for primary cleft palate repair. 66 This takes place in the majority of patients before 13 months of age as set out in the national service specification. 67 The reported rate of RS diagnosis within our cohort is another limitation of this study.…”

American Society of Maxillofacial Surgeons: The Last 25 Years and the Next 25 Years

“…Finally, compounding the increasing supply of surgeons problem is the ever-increasing attempts by other subspecialists to perform these procedures traditionally considered the domain of Plastic surgery, including establishing similar sounding medical boards and associations, adopting similar sounding terminology for centers and professional associations, and even offering post-residency fellowships on cleft surgery and cranial vault remodeling. [37][38][39][40][41] At the core, such tensions can erode trust and make it very difficult to have a real collaborative team, ultimately hurting patient care. Our experience is that patients prefer having a surgeon who can perform the full spectrum of surgical care, from cleft lip to cleft nose to cleft palate to cleft alveolus to cleft maxilla, as well as craniofacial and maxillofacial reconstruction, rather than different subspecialists picking and choosing which parts of their care they can handle.…”