Orthognathic Surgery Rate in Cleft Care

Area of Science:

• Craniofacial Surgery
• Orthodontics
• Cleft Lip and Palate Research

Background:

• Cleft lip and/or palate (CL/P) often leads to midface hypoplasia.
• Orthognathic surgery, specifically Le Fort I (LF1) osteotomy, is a common intervention for this condition.
• Understanding the true need for LF1 in CL/P patients is crucial for accurate patient counseling.

Purpose of the Study:

• To determine the actual incidence of orthognathic surgery referral and performance in patients with repaired CL/P.
• To assess the prevalence of midface hypoplasia requiring LF1 intervention in this population.

Main Methods:

• Retrospective review of 177 patients with CL/P born between 1975-2008.
• Inclusion criteria: ≥18 years at last follow-up, adequate cleft care documentation.
• Exclusion criteria: non-paramedian clefts, comorbid craniofacial syndromes. Primary outcome: LF1 referral/recipiency for midface hypoplasia.

Main Results:

• 51% (90/177) of patients underwent LF1 surgery, while 62% (110/177) were referred.
• Patients with secondary cleft palate involvement showed significantly higher LF1 referral (65%) and surgery rates (55%) compared to those without.
• Bilateral CL/P patients had higher LF1 referral (71%) and surgery rates (84%) than unilateral CL/P patients.

Conclusions:

• The incidence of orthognathic surgery in repaired CL/P patients is substantial, with 51% undergoing LF1, aligning with higher reported rates.
• Referral rates (62%) suggest the true need for LF1 is higher than the number of surgeries performed, highlighting the importance of surgical consultation.
• These findings are critical for informing families about the potential need for midface advancement in CL/P management.