Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan-Feb;33(1):87-92.
doi: 10.1097/SCS.0000000000008002.

Orthognathic Surgery Rate in Cleft Care

Laya Jacob  1   2 , Artur Fahradyan  2 , Philip Paulson  1 , Jordan R Wlodarczyk  1 , Erik M Wolfswinkel  1 , Christian Jimenez  1   2 , Mark M Urata  1   2   3   4 , Jeffrey A Hammoudeh  1   2   3   4
Affiliations

Orthognathic Surgery Rate in Cleft Care

Laya Jacob et al. J Craniofac Surg. 2022 Jan-Feb.

Abstract

Purpose: To determine the true need for orthognathic surgery in patients with repaired cleft lip and/or palate (CL/P) at a high-volume craniofacial center.

Methods: An institutional retrospective review of patients with CL/P born between 1975 and 2008 was performed. Patients with adequate documentation reflecting cleft care who were ≥ 18 years at the time of last craniofacial/dentistry follow-up were included. Patients with non-paramedian clefts or a comorbid craniofacial syndrome were excluded. Primary outcome variable was the total proportion of patients with CL/P who either underwent or were referred for orthognathic surgery Le Fort I (LF1) to correct midface hypoplasia. Secondary outcome variables were associations between cleft phenotype, midface hypoplasia severity, and number of cleft related surgeries with the eventual LF1 referral/recipiency.

Results: One hundred seventy-seven patients with CL/P met inclusion criteria. A total of 90/177 (51%) patients underwent corrective LF1; however, 110/177 (62%) of patients were referred for surgery. Patients with secondary cleft palate involvement were referred for and underwent LF1 at significantly greater rates than those without secondary palate involvement (referred: 65% versus 13%, P = 0.001; underwent: 55% versus 0%, P < 0.001). Patients with bilateral cleft lip/palate were referred for and underwent LF1 at significantly higher rates than those with unilateral cleft lip/palate (referred: 71.0% versus 50.4%, P= 0.04; underwent: 84% versus 71%, P = 0.02). Number of secondary palate surgeries was positively correlated with increased LF1 referral (P = 0.02) but not LF1 recipiency (P = 0.15).

Conclusions: The incidence of orthognathic surgery redundant in patients with repaired CL/P was 51% at our institution, marginally above the higher end of previously reported rates. However, this number is an underrepresentation of the true requirement for LF1 as 62% of patients were referred for surgical intervention of midface hypoplasia. This distinction should be considered when counseling families.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Shi B, Losee JE. The impact of cleft lip and palate repair on maxillofacial growth. Int J Oral Sci 2015; 7:14–17.
    1. Wlodarczyk JR, Brannon B, Munabi NCO, et al. A meta-analysis of palatal repair timing. J Craniofac Surg 2021; 32:647–651.
    1. Denny AD, Bonawitz SC. Le Fort type III osteotomy for midface deficiency in selected cleft palate patients. J Craniofac Surg 1994; 5:295–304.
    1. Gateno J, Engel ER, Teichgraeber JF, et al. A new Le Fort I internal distraction device in the treatment of severe maxillary hypoplasia. J Oral Maxillofac Surg 2005; 63:148–154.
    1. Rachmiel A, Even-Almos M, Aizenbud D. Treatment of maxillary cleft palate: distraction osteogenesis vs. orthognathic surgery. Ann Maxillofac Surg 2012; 2:127–130.