EC Paediatrics

Aim: To analyze the impact of Operation Smile Brazil (OSB) on expanding access to free surgery, decentralizing care, and consolidating multidisciplinary treatment for cleft lip and palate in a Brazilian municipality during the years 2019, 2020, 2023, and 2024.

Methods: Observational, descriptive, cross-sectional study with data collection from the clinical records of participants treated at the missions in Mossoró, Rio Grande do Norte, from 2019 to 2024, made available by OSB, SP.

Results: The relative frequency of a positive family history of congenital anomalies ranged from 31.25% (2019) to 41.89% (2024). The median delay for cleft lip and palate repair ranged from 3.0 years (IQR: 0 - 12.75) to 7.0 years (IQR: 2.5 - 19.5), while for palatoplasty it ranged from 4.5 years (IQR: 0 - 19.5) to 7.0 years (IQR: 1 - 16). Participants treated by the humanitarian missions include not only those undergoing primary, secondary, and tertiary surgeries but also those receiving multidisciplinary follow-up to restore function, aesthetics, and quality of life.

Conclusion: Regarding spatial distribution, Rio Grande do Norte (the study site) showed an average rate of cleft lip and palate of 5.63 cases per 10,000 live births, ranking 11^th in relative frequency in Brazil. The study highlights the need for greater cooperation between public authorities and the third sector to direct priority efforts toward effective regionalization of high-complexity care by investing in the decentralization and capacity-building of reference centers in the Northeast region.

Keywords: Cleft Lip and Palate; Pediatricians; Humanitarian Missions; Brazilian Unified Health System

1. Mossay PA., et al. “Global and oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions”. Advances in Dental Research 2 (2011): 247-258.
2. Monlleó IL., et al. “Diagnostic implications of associated defects in patients with typical orofacial clefts”. Jornal de Pediatria 5 (2015): 485-492.
3. Lewis CW., et al. “The primary care pediatrician and the care of children with cleft lip and/or cleft palate”. Pediatrics 5 (2017): e20170628.
4. Salari N., et al. “Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis”. Journal of Stomatology, Oral and Maxillofacial Surgery2 (2022): e110-e120.
5. Silva AMD., et al. “Epidemiologic profile and prevalence of live births with orofacial cleft in Brazil: a descriptive study”. Revista Paulista de Pediatria 42 (2023): e2022234.
6. da Silva Adriana M., et al. "Comparative study of individuals born with orofacial clefts in the United States and Brazil". ASDOH Faculty Publications 510 (2025).
7. Hackenberg B., et al. "Measuring and comparing the cost-effectiveness of surgical care delivery in low-resource settings: cleft lip and palate as a model”. Journal of Craniofacial Surgery 4 (2015): 1121-1125.
8. Brazil Ministry of Health. SAS/MS Ordinance No. 62, April 19, 1994 (Amended by Ordinance No. 718 of December 20, 2020). Standardizes the registration with the Unified Health System (SUS) of hospitals performing integrated procedures for the aesthetic and functional rehabilitation of patients with cleft lip and palate.
9. Monlleó ILL and Gil-da-Silva-Lopes VL. “Craniofacial anomalies: description and assessment of general care characteristics within the Unified Health System. (Anomalias craniofaciais: descrição e avaliação das características gerais da atenção no Sistema único de Saúde)”. Cadernos de Saúde Pública5 (2006): 913922.
10. National Registry of Health Facilities. Hospitals accredited by the SUS. (Cadastro Nacional de Estabelecimento e Saúde. Hospitais habilitados pelo SUS).
11. American Cleft Palate-Craniofacial Association (ACPA). “Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences”. Cleft Palate Craniofacial Journal 1 (2018): 137-156.
12. Abreu MH., et al. “Temporal trend in the reported birth prevalenceof cleft lipand/or cleft palate in Brazil, 2000 to 2013”. Birth Defects Research Part A: Clinical and Molecular Teratology9 (2016): 789-792.
13. William Shaw. “Global strategies to reduce the health care burden of craniofacial anomalies: report of WHO meetings on international collaborative research on craniofacial anomalies”. Cleft Palate Craniofacial Journal 3 (2004): 238-243.
14. World Health Organization (WHO). Birth defects surveillance: a manual for programme managers, 2^nd edition, December 2020.
15. Chung KY., et al. “A systematic review of the cost-effectiveness of cleft care in low- and middle-income countries: what is needed?” Cleft Palate Craniofacial Journal 12 (2023): 1600-1608.
16. Spina V., et al. “Classification of cleft lip and cleft palate: suggested changes. (Classificação das fissuras lábio-palatais: sugestão de modificação)”. Revista do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo 1 (1972): 5-6.
17. Monlleó IL. Craniofacial anomalies: description and evaluation of treatment under the Brazilian Unified Health System. (Atenção a pessoas com anomalias craniofaciais no Brasil: avaliação e propostas para o sistema único de saúde). 2008.247f. Tese (Doutorado em Ciências Médicas) - Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP (2008).
18. Silva RS., et al. “The panorama of cleft lip and palate live birth in brazil: follow-up of a 10-year period and inequalities in the health system”. The Cleft Palate-Craniofacial Journal12 (2022): 1490-1501.
19. Diaz MD. “Socio-economic health inequalities in Brazil: gender and age effects”. Health Economics 2 (2002): 141-154.
20. Standards for Approval of Cleft Palate and Craniofacial Teams. Comission on Approval of Teams. Revised November 2022.
21. World Health Organization (WHO). Birth defects surveillance: a manual for programme managers, 2^nd edition, December 2020.
22. de Sousa GFT and Roncalli AG. “Orofacial clefts in Brazil and surgical rehabilitation under the Brazilian National Health System”. Brazilian Oral Research 31 (2017): e23.
23. Looze GF., et al. “Epidemiological profile of patients with cleft lip and palate treated at a referral hospital in the interior of Alagoas. (Perfil Epidemiológico de pacientes com fissura labiopalatinas atendidos em um hospital de referência do interior de Alagoas)”. Brazilian Journal of Health Review 3 (2023): 8747-8766. 
24. Amstalden-Mendes LG., et al. “Time of diagnosis of oral clefts: a multicenter study”. Jornal de Pediatria 87 (2011): 225-230.
25. Denadai R and Lo Lun-Jou. “Reducing delayed detection of isolated cleft palate-related deformity: a call for routine intraoral examination of newborns”. Jornal de Pediatria 4 (2024): 350-359.