Cleft Care India Study: A National Audit on Patients with Non-Syndromic Unilateral Cleft Lip and Palate: Surgical Procedures and Outcomes.

ObjectiveTo assess the surgical protocols followed in the treatment of non-syndromic UCLP across Indian cleft centres and identify factors influencing secondary surgical outcomes.DesignProspective cross sectional design.SettingThe study was conducted in 14 sary/tertiary care comprehensive cleft centres.ParticipantsThe study included 307 patients with non-syndromic UCLP across three age groups (5, 12, and 20 years) from 14 centres nationwide.OutcomesData was collected through a standardized web-based form. Variables recorded included surgeon specialty and experience, surgical sequence, presurgical orthopaedics, primary surgical techniques, and their association with the need for secondary procedures such as lip/nose revision, velopharyngeal surgery, fistula repair, and alveolar bone grafting. Descriptive statistics were generated, and associations between variables were analysed using Fisher's exact test.ResultsMillard's technique was the most commonly used approach for primary lip repair across all age groups. Presurgical orthopedic plates, nasal conformers, and the specific lip repair technique were not significantly associated with the need for lip or nasal revision surgery, although the wide confidence intervals indicate considerable uncertainty in these estimates. Similarly, the type of palatal repair and use of intravelar veloplasty were not significantly associated with fistula formation or the need for secondary velopharyngeal or fistula repair procedures. Across centres, wide variation existed in techniques used, but no one approach showed superiority in reducing secondary surgery needs.ConclusionDespite the observed variability in surgical weak associations were found between specific surgical techniques or surgeon-related factors and the need for secondary surgical interventions. The wide confidence intervals highlight the uncertainty of these findings and the need for further national-level audits, underscoring the challenge of establishing best practices in cleft care without robust systems for comprehensive data collection and consolidation.