An enduring memory of isolating at home during the pandemic was discovering just how awful midday television is. Worst of all was the banality of the commercial advertising. The plight of Anatolian donkeys, the encouragement to fund one's own funeral costs or the sale of tacky jewellery did not impress me. An exception, which did lead me to dip into my pension fund, was an appeal to fund expert care for children with facial clefts, in some of the poorest countries. I was immediately impressed that such overseas aid is a major component of this book, with some very thought-provoking coverage of how to meet the challenges presented.
As our UK economy tanks, this book does represent a significant dollar investment, but, for any unit contributing to management of clefts, I thought it well worth that. Over 700 pages of text, in an A4-sized book, was sure to be comprehensive, but it proved to be far more than ‘just’ a surgical manual. As such it is superb however, helped by coloured operative photography and coloured art-work (Dr Low is truly a gifted artist). Approximately 400 pages do deal with the surgical correction, in an appealing step-wise fashion, of every variety of facial, lip and palate imaginable. I was delighted to see faces pre- and post-operatively that were not spoiled by black rectangles over the eyes, and, where cosmesis is as important as function, this beautifully illustrated what could be achieved.
The multidisciplinary approach is emphasised throughout, making this of value to otolaryngologists, dental and maxillofacial surgeons, speech and language pathologists, and child (indeed also adult) psychologists. Many chapters focus on the individual contribution of each to care. The chapter for anaesthetists presents the challenges of the many congenital disorders associated with cleft defects.
Personal favourite chapters included those on primary and secondary rhinoplasty. In the former, photographs after decades of follow up show that the earliest surgery need not increase scarring and distort growth, as we once warned.
A major section deals with the provision of care in outreach settings, especially in low-income countries. The text reproduces the Global Smile Foundation site survey checklist and staffing requirements, which are quite demanding. Quality assurance and safety issues in such an environment merit separate chapters, but I was most impressed by the use of simulation training to develop and then assess local expertise. ‘Teach a man to fish’ (I am sure you know the rest) was how the Chinese philosopher Lao Tzu phrased it, and this book, with its many videos, does much to assure that it applies to helping children afflicted with such developmental abnormalities.
