Cleft lip and palate surgery carried out by one team in Uganda: where have all the palates gone?

OBJECTIVE: To determine the distribution of clefts in our operated population in comparison with data in the world literature.

DESIGN: A retrospective review of hospital-based cleft procedures undertaken in Uganda over a 10-year period by one surgical team.

PATIENTS: 1304 newly presenting cleft patients were identified and analyzed by sex, laterality, and type of cleft, and data were compared with the literature.

RESULTS: We found male predominance in cleft lip (CL) and/or palate patients and female predominance in isolated cleft palate (CP) patients. Left-sided CLs presented more frequently than right-sided, bilateral, and midline cleft lips at a ratio of 50∶38∶11∶1. Patients presented most commonly with an isolated CL, followed by cleft lip and palate (CLP), with a small number presenting with isolated CP (966, 306, and 32, respectively).

CONCLUSION: The distribution of sex and laterality broadly correlates with findings of other studies; however, a large discrepancy in the proportions of CL, CLP, and CP is apparent. Much higher numbers of CLs and much lower numbers of CLP and CP presented than would be expected in comparison with worldwide literature (2% of patients had an isolated CP). It is hypothesized that the low numbers of patients presenting with combined CLP and CP are due to high mortality among this cohort. If this hypothesis is correct, then in this series of 1304 cleft patients, as many as 3526 CP patients (91% of all CPs) are missing and probably died before undergoing surgical correction.