Timing of Primary Cleft Lip and Palate Surgery in India: A Multi-Regional Analysis Using Validated Institutional and Published Data

Abstract

Background: Timely cleft lip and/or palate (CLP) surgery is critical for speech, feeding, and psychosocial outcomes. Ideal surgical benchmarks recommend lip repair by 12 months and palate repair by 18 months. However, delays are common in India.

Objective: To evaluate the timing of primary cleft surgeries in India using validated institutional and published information across various regions.

Methods: Eight sources from Sub-Himalayan, Himachal Pradesh, Tamil Nadu, Bihar, Uttar Pradesh, Maharashtra, and national datasets were analyzed. Metrics included mean/median age at lip and palate repair and proportion of patients treated on-time (≤12 months for lip, ≤18 months for palate).

Results: AIIMS Patna reported the lowest median lip repair age (11 months). Other centers reported delayed presentations: Diwana (33.6 months), Prabakaran (36 months), Gupta (162 months). On-time lip repair ranged from 15% (TISS report) to 43.6% (Dvivedi). On-time palate repair was consistently <20%.

Conclusion: Most Indian cleft patients undergo delayed surgery. Barriers include poor nutrition, referral delays, and lack of caregiver awareness. Improvements require integrated systems of early detection, caregiver education, and decentralized surgical access.