{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:11:15Z","timestamp":1788667875972,"version":"build-2803163510"},"reference-count":89,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare cleft lip and palate management between the USA and Guatemala, focusing on surgical timing, secondary procedures, and multidisciplinary access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicenter, retrospective cohort study (2011\u20132024); nonrandomized, with anonymized clinical and surgical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Vanderbilt University Medical Center (USA) and Moore Pediatric Surgery Center (Guatemala). U.S. care was continuous; care in Guatemala was provided through short-term surgical missions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>1693 patients aged 0\u201321 years with cleft lip and\/or palate (790 Guatemala; 903 USA). Patients with Tessier clefts or non-Guatemalan residency (for the Guatemalan cohort) were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Primary and secondary cleft surgeries and multidisciplinary interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measure<\/jats:title>\n                    <jats:p>Age at primary surgery, cleft type, sex, secondary procedures, palatal fistula, velopharyngeal insufficiency, dental\/ear interventions, and sociodemographics (Guatemala).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Guatemalan patients underwent primary cleft lip and palate repairs at significantly older ages (\n                      <jats:italic toggle=\"yes\">p\u2009&lt;\u2009<\/jats:italic>\n                      .001) and had higher rates of palate fistula (24% vs. 7%), fistula repair (13% vs. 7%), and lip revision (15% vs. 8%) (\n                      <jats:italic toggle=\"yes\">p\u2009&lt;\u2009<\/jats:italic>\n                      .001). Access to multidisciplinary care was greater in the USA (myringotomy tubes: 70% vs. 10%; dental restoration: 24% vs. 17%;\n                      <jats:italic toggle=\"yes\">p\u2009&lt;\u2009<\/jats:italic>\n                      .001). Among Guatemalan patients, 53% lived in rural regions and traveled a mean 3.3\u2005h to access care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Significant disparities exist in cleft lip and palate management between Guatemala and the USA, marked by delayed surgical intervention beyond the optimal developmental window. Overcoming systemic, geographic, and socioeconomic barriers through integrated, sustainable, locally supported care models is critical to enhancing outcomes in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261420132","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T14:44:47Z","timestamp":1771339487000},"page":"3551-3564","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Comparative Study of Cleft Management in Different Economic Settings: United States Versus Guatemala"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6224-3143","authenticated-orcid":false,"given":"Emmanuel","family":"Tuchez","sequence":"first","affiliation":[{"name":"Moore Pediatric Surgery Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Diego","family":"Rojas Camacho","sequence":"additional","affiliation":[{"name":"Moore Pediatric Surgery Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalpnaben R","family":"Patel","sequence":"additional","affiliation":[{"name":"Vanderbilt Children's Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilin","family":"Zhao","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosangela","family":"Sanchez Puga","sequence":"additional","affiliation":[{"name":"Moore Pediatric Surgery Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9490-3694","authenticated-orcid":false,"given":"Ryan H","family":"Belcher","sequence":"additional","affiliation":[{"name":"Vanderbilt Children's Hospital"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D","family":"Phillips","sequence":"additional","affiliation":[{"name":"Vanderbilt Children's Hospital"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/2191-1991-2-22"},{"key":"e_1_3_3_4_2","volume-title":"Health in the Americas+ Country Profile: Guatemala","author":"Pan American Health Organization (PAHO)","year":"2024","unstructured":"Pan American Health Organization (PAHO). 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