14 April 2020

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14 April 2020

Dear Colleagues,

The effects of the Corona virus pandemic are being felt throughout the world, and in every country in Europe healthcare is one of the areas impacted. Medical supplies and services in hospitals throughout Europe are being re-prioritised to cope with the COVID-19 crisis and elective surgical care is being postponed. Only urgent oncologic and emergency trauma surgery is being performed, and this situation could last for many months.

Understandably in the field of cleft palate and craniofacial anomalies there is anxiety among patients, parents, surgeons and carers that after the pandemic, many hospitals will need to prioritise non-acute surgery. In Europe we have co-operative networks that over the years in this field have served us well and The European Cleft Palate Craniofacial Association would like to facilitate the dialogue and discussion with health authorities about prioritizing surgical interventions to ensure optimum care in these difficult circumstances to minimize adverse consequences for the patients under our care.

We have devised a simple questionnaire aimed towards defining acceptable time frames or maximum ages when various types of cleft or craniofacial surgery should be performed after the COVID-19 crisis; with acknowledgement that there will be differences in the post COVID – 19 response according to individual country circumstances and policies.

Our main aim is to ensure that our patients and the families of infants born with these conditions throughout Europe obtain the best possible care in these difficult times.

This document will not take more than 7 min to complete Kind regards

Corstiaan Breugem (Plastic Surgeon, Amsterdam, The Netherlands) Costanza Meazzini (Orthodontist, Milano, Italy)

Hans Mark (Plastic Surgeon, Gothenburg, Sweden) Gareth Davies (European Cleft Organisation)

Peter Schachner (Maxillofacial Surgeon, Salzburg, Austria) Mechelle Collard (Pediatric Dentistry, Bristol, United Kingdom)

Debbie Sell ( Speech and Language Pathologist, Londen, United Kingdom) Marieke Markensteijn (Cleft Nurse, Amsterdam, the Netherlands)

Luca Autelitano (Maxillofacial Surgeon, Milano, Italy)

Angela Rezzonico (Speech and Language Pathologist, Milano, Italy) Fabio Mazzoleni (Maxillofacial Surgeon, Milano, Italy)

Giorgio Novelli(Maxillofacial Surgeon , Milano, Italy) Peter Mossey (Orthodontist, Dundee, Scotland)

Martin Persson (Psychologist, Kristianstad, Sweden)

Felicity Mehendale (Plastic Surgeon, Edinburgh, Scotland, United Kingdom)

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Alexander Gaggl (maxillofacial Surgeon, Salzburg, Austria) Christine van Gogh (ENT surgeon, Amsterdam, The Netherlands) Petra Zuurbier (Orthodontist, Amsterdam, the Netherlands) Siegmar Reinart (Maxillofacial Surgery, Tuebingen, Germany)

Questionnaire:

Name:

Specialty:

City Country

Current situation as a result of coronavirus:

• To what extend has your cleft/craniofacial centre been affected by Coronovirus?

(Martin’s suggested sliding 0 – 100 per cent bar)

Are you currenty still undertaking cleft and/or craniofacial surgery?

Yes/No/Some

CLEFT SURGERY:

How many months delay from your protocol would be acceptable for primary cleft lip surgery?

• 3 months

• 6 months

• 9 months

• 12 months

• No priority / relevance in time for closure

• I’m not involved in this type of surgery

• Comments

Primary palate closure (including the soft palate) should be performed before the age of

• 9 months

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• 12 months

• 15 months

• 18 months

• 24 months

• Comments

Once it is decided that placement of middle ear tubes is mandatory, how many months delay from your protocol would be acceptable ?

• 3 months

• 6 months

• 9 months

• 12 months

• No priority / relevance in time for surgery

• Comments

Once it is decided that children with Robin sequence and obstructive breathing problems do not respond to positional change and surgery is necessary, should this be done within

• Immediately (as soon as possible)

• 4 weeks

• 8 weeks

• Comments

Once it is decided to do secondary cleft lip surgery, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

Once it is decided to do a palatal fistula closure, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

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Secondary speech improving surgery for nasal speech is mandatory based on the Speech and Language Therapist’s recommendation and agreed with the surgeon. What is the latest time that VPI surgery should be performed following this recommendation:

•3 months

•6 months

•12 months

•No priority / relevance in time for surgery

•I’m not involved in this type of surgery

•Comments

If patients with an alveolar cleft are ready for bone grafting ( possibly with orthodontic pretreatment), how many months delay from your protocol would be acceptable?

• 3 months

• 6 months

• 12 months

• Comments

Once it is decided to do secondary cleft nose surgery, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

Once it is decided to do a le Fort osteotomy, with orthodontic pretreatment, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

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Could you please describe briefly from your opinion how the Coronavirus will affect your cleft and/or craniofacial treatment at your workplace - short and long term.

……….

Is there any support your workplace might need to mitigate the effects of the Coronavirus?

………..

Microtia care

Once it is decided to do a microtia ear reconstruction, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

Once it is decided that a patients needs BCD surgery, this should be performed within

• 3 months

• 6 months

• 12 months

• Comments

Craniofacial conditions Craniosynostosis

Once it is decided to do a craniosynostosis correction (without signs of intracranial pressure) by using springs/endoscopic strip removal, this should be performed before the age of

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• 6 months

• I will decide to perform an open procedure

• Comments

Once it is decided to do a craniosynostosis correction (without signs of intracranial pressure) by using an open reconstruction, this should be performed before the age of

• 9 months

• 12 months

• 18 months

• Comments

Once it is decided to do a craniosynostosis correction (with signs of intracranial pressure, this should be performed within

• As soon as possible

• 4 weeks

• 2 months

• Comments

Once it is decided that children with syndromic craniosynostosis (a.g Apert/Crouzon

syndrome) have signs of obstructive breathing / OSAS and surgery is necessary, should this be done within

• 3 months

• 6 months

• Comments

Once it is decided that children with syndromic craniosynostosis (a.g Apert/Crouzon syndrome) have signs of proptosis and surgery is necessary, should this be done within