Reply: Evaluation and Implementation of a High-Fidelity Cleft Palate Simulator (2018)

Sir: We would like to thank Dr. Pang et al. for their interest in the article “Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator.”1 We are thankful for the opportunity to provide insight into their work. The authors have described a cleft palate training platform that incorporates pig tongue to replicate the palatal soft tissue, and surgical gloves to provide a simulated oral cavity. The article highlights the technical difficulty of cleft palate repair and the unique challenges of teaching and learning cleft palate surgery warranting an effective simulator. The strength of the presented design is the conceptual framework of using alternative materials and methods to develop an economical training platform that may be more accessible in the developing world. Although the presented design is economical, it represents a task trainer that allows practice of some of the steps of a cleft palate repair procedure. The high-fidelity cleft palate simulator is a realistic representation of cleft anatomy and repair.1–4 It allows a trainee to practice cleft palate surgery from start to finish. This is an important feature of the simulator, as it allows a trainee to work through all of the surgical steps, understanding the appropriate sequence and how this contributes to a successful repair. The use of animal tissue to replicate the human soft palate is a very creative approach. Material testing is required to determine whether pig tongue is a realistic representation of the human velum. The important relationship of the five velar muscles is not represented. Understanding the role of these muscles as it relates to surgical technique is important in performing a successful repair. In addition, the precise dimensions of the infant oral cavity are required to adequately simulate the challenges of working within the appropriate surgical space. The high-fidelity cleft palate simulator underwent extensive development and validation to ensure that it is anatomically accurate, incorporating the necessary components, dissection planes, and synthetic tissue.1–4 The ultimate goal of a cleft palate simulator is for trainees to gain experience that can translate to real cleft palate surgery. In addition, cleft palate surgery requires attention to fine detail to ensure optimal outcomes. No simulator can completely replicate the exact experience of operating on a real infant. However, one must strive for this goal. The economics of the platform are very important, but ensuring that the right skills are being learned is a priority. We must ensure that we do not sacrifice the quality of the training platform, and ultimately the right balance must be struck to provide a practical and effective training strategy. The authors should be commended for finding a creative approach that strives to provide an economical cleft palate surgery training platform. We encourage the authors to continue to evolve the design and to perform validation testing to build evidence for its value as an effective cleft palate simulator that can be more readily implemented in the developing world. DISCLOSURE The cleft palate simulator is available commercially and sold by Simulare Medical Corp. (Toronto, Ontario, Canada). Drs. Podolsky, Fisher, Wong, Drake, and Forrest are shareholders of Simulare Medical Corp. Dr. Cheng has no financial interest to report. Dale J. Podolsky, M.D., Ph.D.Division of Plastic and Reconstructive SurgeryUniversity of TorontoToronto, OntarioCenter for Image Guided Innovation and TherapeuticInterventionToronto, Ontario Homan Cheng, M.D.Division of Plastic and Reconstructive SurgeryVancouver Island Health AuthorityVictoria, British Columbia David M. Fisher, M.D.Karen W. Wong Riff, M.D., Ph.D.Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto, Ontario James M. Drake, M.D., M.Sc.Center for Image Guided Innovation and TherapeuticInterventionToronto, OntarioDivision of NeurosurgeryThe Hospital for Sick ChildrenToronto, Ontario Christopher R. Forrest, M.D., M.Sc.Division of Plastic and Reconstructive SurgeryThe Hospital for Sick ChildrenToronto, Ontario, Canada