A Comparative Study of Cleft Management in Different Economic Settings: United States Versus Guatemala

Objective To compare cleft lip and palate management between the USA and Guatemala, focusing on surgical timing, secondary procedures, and multidisciplinary access. Design Multicenter, retrospective cohort study (2011–2024); nonrandomized, with anonymized clinical and surgical data. Setting Vanderbilt University Medical Center (USA) and Moore Pediatric Surgery Center (Guatemala). U.S. care was continuous; care in Guatemala was provided through short-term surgical missions. Patients 1693 patients aged 0–21 years with cleft lip and/or palate (790 Guatemala; 903 USA). Patients with Tessier clefts or non-Guatemalan residency (for the Guatemalan cohort) were excluded. Interventions Primary and secondary cleft surgeries and multidisciplinary interventions. Main Outcome Measure Age at primary surgery, cleft type, sex, secondary procedures, palatal fistula, velopharyngeal insufficiency, dental/ear interventions, and sociodemographics (Guatemala). Results Guatemalan patients underwent primary cleft lip and palate repairs at significantly older ages ( p < .001) and had higher rates of palate fistula (24% vs. 7%), fistula repair (13% vs. 7%), and lip revision (15% vs. 8%) ( p < .001). Access to multidisciplinary care was greater in the USA (myringotomy tubes: 70% vs. 10%; dental restoration: 24% vs. 17%; p < .001). Among Guatemalan patients, 53% lived in rural regions and traveled a mean 3.3 h to access care. Conclusions Significant disparities exist in cleft lip and palate management between Guatemala and the USA, marked by delayed surgical intervention beyond the optimal developmental window. Overcoming systemic, geographic, and socioeconomic barriers through integrated, sustainable, locally supported care models is critical to enhancing outcomes in resource-limited settings.