Cleft Lip and Palate: From Origin to Treatment.

Diego Wyszynski has done an admirable job of assembling a collection of reviews of various aspects of the etiology and treatment of oral clefts. This 500-page monograph is divided into three sections: “Basic Principles” (embryology, clinical features, epidemiology, and genetics); “Treatment” (surgery, speech care, dentistry, otolaryngology, etc.); and “Public Health Issues” (prevention, insurance coverage, ethical issues, and education). As with all edited monographs, some essays are more scholarly than others; a few are rather poor. Nevertheless, this book achieves its stated intention of “addressing issues that are relevant to clinicians, researchers, and family members.” Of particular value to clinicians and well-informed family members is the section on treatment. The treatment of patients with oral clefts, from birth to adulthood, requires a well-coordinated team effort. This section does a good job of conveying the global nature and specific details of this comprehensive care. Thus, chapters 24–34 are highly recommended, as are chapters 36–39 in the section on public health issues. One important misstep in this presentation is the lack of succinct clarity regarding our present knowledge of oral cleft etiology. In 1949, Curt Stern, writing in his text Principles of Human Genetics, noted: “Harelip and cleft palate are developmental abnormalities which have a genetic basis. In many pedigrees, they depend on the cooperation of specific alleles at several autosomal loci, and, in addition, require the presence of mostly uncontrolled environmental factors.” In 2002, there is little else we can add. F. Clarke Fraser, in his foreword to Wyszynski’s monograph, cogently tells us why: “Epidemiologic studies are hampered by the fact that, for an uncommon multifactorial trait, it is virtually impossible to assemble groups large enough to allow statistically valid comparisons of potentially significant factors such as prenatal events, susceptibility genes, social class, and race.” Unfortunately, one is left to conclude that much of what is contained in chapter 3 and chapters 16–22 is much ado about very little. I hope that, someday, this will be different. Today, at bottom, we must rely entirely on the information in Carmella Stadter’s chapter (31) on genetic counseling and empiric risk calculation. This message is lost amid the genomic hype. In a book “addressing issues … relevant to clinicians … and family members,” this should have been in neon. On balance, this monograph has more to recommend it than not. It should be on the shelf of all those with a need to know about clefts.