Clinical, Demographic, and Socioeconomic Profile of Cleft Lip and Palate in Eastern India

ABSTRACT

Aim:

To determine the clinical, demographic, and socioeconomic profile of individuals with cleft lip and/or palate (CLP) at a high-volume center using data collected over 5 months in 2024.

Materials and Methods:

A prospective cohort observational case series was conducted within the cleft center departments of Orthodontics and Plastic Surgery at Santosh Dental College, Ghaziabad, Uttar Pradesh. The study examined age, sex, family history of clefts, socioeconomic status, and cleft types across various regions. A multidisciplinary approach, including orthodontic and dental treatments, speech therapy, and nutritional support, was used. The frequency and types of surgeries were evaluated at different age intervals: 0–5 years, >5–12 years, and >13 years. Secondary outcomes included parental literacy levels and pregnancy-related complications.

Results:

The study included 491 cleft patients with a mean age of 13.5 years. 45.41% belonged to the lower-middle class socioeconomic status, with a male-to-female ratio of 1.1:1. Bihar had the highest number of patients (204). Unilateral cleft lip and palate were predominant, especially among males. Common surgeries for 0–5 years were lip and hard palate closure, while older children underwent Secondary Alveolar Bone Grafting (SABG) and Rhinoplasty. 63% of patients actively participated in speech therapy, reflecting significant engagement with the interdisciplinary approach.

Conclusion:

This study provides foundational data on cleft patients treated at a high-volume center in Eastern India, highlighting the importance of a comprehensive multidisciplinary approach in managing CLP.

INTRODUCTION

Orofacial clefts (OCs) are among the most common congenital anomalies in the craniofacial region, resulting from both genetic and environmental factors.[1] The worldwide incidence of cleft lip and palate (CLP) is approximately 1 in 700 births, with higher rates in the Asian population, around 2.0 per 1000 live births.[2] Incidence rates vary globally, and in India, the All India Institute of Medical Sciences (AIIMS) in New Delhi reports a CLP incidence of 1.4 per 1000 live births.[3] Effective treatment of orofacial clefts requires timely and age-appropriate interventions to ensure functional and aesthetic well-being. The treatment process is complex, involving multidisciplinary and interdisciplinary approaches.[4,5] Successful management demands coordinated care from various specialties, often necessitating multiple phases of surgical interventions.[6,7] Despite India’s extensive medical network, interdisciplinary cleft care is limited to a few hospitals, resulting in significant variations in treatment quality and outcomes.

MATERIAL AND METHODS

This prospective cohort observational case series was conducted in the cleft center departments of Orthodontics and Plastic Surgery. Data were collected by healthcare providers and professionals from patients hailing from Uttar Pradesh and other states of North and East India (mainly Bihar, Jharkhand, and West Bengal) who underwent surgery in our hospital in the last 5 months (January 2024 to May 2024) under the Smile Train program. The study was carried out at the G. S. Memorial Plastic Surgery Hospital and Trauma Center, Varanasi, in conjunction with Santosh Dental College, Ghaziabad, Uttar Pradesh. Data on sociodemographic profile and clinical characteristics, including age at presentation, gender, awareness of surgery, place of residence, and diagnosis, were collected through questionnaires administered by two authors.

Inclusion criteria

Patients who visited G.S. Memorial Plastic Surgery Hospital and Trauma Center and received treatment aged between newly born to 20 years, including any cleft surgery, orthodontic treatment, speech therapy, and nutrition support, in the last 5 months (January 2024–May 2024), under the Smile Train program.

Exclusion criteria

Patients who visited the hospital but did not receive any treatment were not included in the Smile Train Program (free treatment) or whose data collection was incomplete.

Statistical analysis

IBM SPSS statistical software version 23 was used for data analysis and graphic representation.

RESULTS

The study conducted on 491 cleft patients between January and May 2024 at G.S. Memorial Hospital provides a detailed analysis of demographic factors, cleft types, surgical interventions, and interdisciplinary treatment strategies. The mean patient age was 13.5 years, with a male-to-female ratio of 1.1:1 (274 males, 241 females). Bihar had the highest number of patients (204). Unilateral cleft lip and palate were most common, especially among males, while isolated cleft palate was more frequent in females. Socioeconomically, 45.41% of patients were from the lower-middle class. Surgical interventions varied by age, with lip and hard palate closures common in 0–5 years and SABG and rhinoplasty in the >5–12 years group. The interdisciplinary treatment approach included orthodontic and dental care (30% participation), speech therapy (63% participation, starting at 2.5 years), and nutritional support (98% participation). This comprehensive care model emphasizes the importance of early intervention and a holistic approach to treatment [Tables 1–5].

Table 1.

Gender distribution of cleft patients

Total Number of cleft patients	Male	Female
491	274	241

Table 5.

Interdisciplinary treatment approach

Interdisciplinary treatment	No	Yes
Orthodontic treatment	69.9%	30.1%
		• NAM -0.81%
		• Mixed Dentition Stage - 15.48%
		• Permanent Dentition stage - 11.81%
		• Undergone Mixed Dentition and Continuing Permanent Dentition Orthodontic treatment - 2.04%
Speech therapy	36.4%	63.6% Starting speech therapy at Mean age of 2.5 years
Nutrition treatment	1.2%	98.8% G.S Memorial Hospital

Table 2.

Area distribution of cleft patients

State (Location)	Number of cleft patients	Male	Female
Bihar	204	104	100
Jharkhand	32	17	15
Uttar Pradesh	190	110	80
West Bengal	54	25	29
Sikkim	2	2	0
Madhya Pradesh	5	4	1
Chhattisgarh	4	0	4

Table 3.

Distribution of patients based on types of cleft

Cleft type	Number of cleft subjects	Males	Females
B/L C/L/A/P	159	88	71
U/L C/L/A/P Left side	221	124	97
U/L C/L/A/P Right side	45	20	25
(U/L C/L Left side)	5	4	1
Palate	56	22	34
Others	5	4	1

Table 4.

Number of surgeries in different age groups

Number of patients 0-5 years	Number of patients More than 5-12 years	Number of patients More than 12 years
469	270	12
Lip alone - 91	SABG alone - 105	Orthognathic Surgery - 2
Lip and hard palate - 334	SABG with Secondary Rhinoplasty - 135	Anterior fistula closure - 7
Lip, hard palate with primary rhinoplasty - 42	SABG, secondary rhinoplasty and Fistula closure - 30	Lip and hard palate - 3 (unoperated cleft lip and palate)

DISCUSSION

Unilateral cleft lip and palate on the left side were significantly more common than on the right side, with males being more frequently affected. Bilateral cleft cases were also more prevalent in males and had a higher incidence than isolated cleft lip or isolated cleft palate cases.[4] These findings align with previous research, such as that by Kharbanda OP et al. and Blanco-Davila, who noted similar trends. In addition, isolated cleft palate was more common in females. The study also found a high prevalence of clefts among lower middle-class families, with 45.41% of patients coming from this socioeconomic group, and a significant portion of parents were illiterate or had only attended primary or secondary school.[5,6]

The prevalence of cleft conditions varied by state, with Bihar exhibiting the highest incidence, followed by Uttar Pradesh. This state-wise analysis underscores the need for tailored healthcare strategies to address regional differences in cleft manifestations. Despite the implementation of interdisciplinary team approaches, a significant portion of patients remained unaware of their orthodontic treatment needs due to limited awareness and economic constraints. High engagement in speech therapy was noted, likely due to accessible telecommunication centers. However, many patients failed to follow-up with treatments at each stage, as outlined in the management protocols.[7] The study’s limitations include referral and selection bias, and future research should focus on long-term studies with larger sample sizes and comprehensive birth rates to determine incidence and prevalence rates accurately. Identifying and mitigating factors that limit access to orthodontic and dental care is essential to improve overall treatment outcomes for cleft patients. This study emphasizes the complexity of cleft lip and palate management and the importance of interdisciplinary collaboration, early intervention, and tailored approaches to improve patient outcomes and quality of life.

CONCLUSION

Bihar has demonstrated a higher prevalence of cleft cases compared with other Eastern states such as Uttar Pradesh, West Bengal, Jharkhand, and Sikkim, with males exhibiting a higher susceptibility than females. However, palatal cleft cases show a higher prevalence in females. In unilateral cleft cases, left-sided clefts are more common than right-sided ones in both genders. The age group of 0 to 5 years witnessed the highest number of surgeries.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.