Timing of Primary Surgery for Cleft Palate

The recent trial by Gamble et al. (Aug. 31 issue)1 on the timing of cleft palate repair is a valuable addition to cleft-focused research. However, the lack of detailed information characterizing isolated cleft palate deformity and surgical technique could hinder surgeon readers from fully comprehending the findings. Subjective assessment of anatomical presentation for exclusion criteria (103 infants, according to Table S9 in the Supplementary Appendix of the article, available at NEJM.org) may introduce bias, potentially affecting the generalizability of the findings. Such subjectivity appears to generate a cohort restricted to narrow cleft palates, despite the successful performance . . .