Treatment of Cleft Lip and Palate in the State of Amazonas: An Analysis of the Factors Influencing Surgical Access

Cleft lip and palate impacts multiple organs and systems, as well as the self-esteem and quality of life of affected individuals. Patients residing in remote areas experience delays in starting treatment, increasing the age of primary surgery. In Amazonas, there is only one specialized center in the largest State by territorial area in Brazil. Limited transportation infrastructure and difficulties accessing healthcare services contribute to the delayed diagnosis and repair of this deformity. This study aimed to investigate the prevalence of CLP in Amazonas and identify the factors contributing to delays in surgical treatment. An observational, cross-sectional, and retrospective study was conducted with patients aged 0 to 17 years, nonsyndromic, with cleft lip and palate, who underwent primary surgeries between 2019 and 2021 at Dr Fajardo Children's Hospital in Manaus. The study sought to analyze the socioeconomic and demographic aspects that delay surgical treatment. A total of 181 medical records were analyzed. Surgical delays occurred in 61.9%, primarily due to low weight (43.9%), followed by respiratory infections (31.6%). Approximately 62.7% of patients used river transport to reach the capital. Patients with CLP underwent lip repair older than CL, and patients with CP underwent palatal repair later than recommended by the literature. CL decreased the likelihood of delays (OR: 0.148, 95% CI: 0.033-0.65, P = 0.013). Individuals with low nutritional and socioeconomic status showed a longer delay in surgical treatment in Amazonas, highlighting the deficiency in nutritional support and access to the reference center. The prevalence in the State is consistent with other regions of Brazil.