Outcomes and Complications of Cleft Lip and Palate Surgery During International Surgical Outreach: A Systematic Review

BACKGROUND: Evaluating cleft lip and/or palate (CLP) surgical outcomes from short-term international surgical outreach in low- and middle-income countries is essential for high-quality care. OBJECTIVE: To quantify reported surgical outcomes and complications on CLP surgery performed during international outreach, as measured by speech results and complications, including wound dehiscence, hemorrhage, and fistula formation. METHOD: A systematic review of PubMed and EMBASE identified full-text English-language studies from 1985 to 2025 describing CLP repair in international outreach. Outcomes were extracted per-patient and per-procedure, including complication rates, speech findings, and patient-reported results. RESULTS: Of 450 studies screened, 34 met inclusion criteria (26,529 patients; 30,864 procedures). The mean follow-up was 14.2 months (range: 1 week-11 years). The pooled complication rate was 3.3% per-procedure (1,015/30,864) and 3.8% per-patient (1,015/26,529). Per-procedure complication rates were 2.1% (285/13,823) for lip and 3.8% (642/16,745) for palate repair. The most frequent overall complications were wound dehiscence (1.3%; 400/30,864), hemorrhage (0.4%; 129/30,864), and infection (0.3%; 102/30,864). Among cleft palate repairs, palatal fistula (1.6%; 271/16,745) and flap necrosis (0.5%; 77/16,745) were most common. Four studies described improved speech, social functioning, and satisfaction postoperatively. CONCLUSION: Short-term CLP surgical outreach demonstrates early complication rates comparable to high-resource settings, although limited follow-up likely underestimates true adverse events.