Do Patients With Cleft Lip and Palate Have an Increased Risk of Short-Term Complications After Le Fort I Osteotomy?

Patients with cleft lip and palate (CL/P) often require Le Fort I maxillary advancement for correction of maxillary hypoplasia. Because of scar tissue formation, aberrant anatomy, and diminished vascularity, these patients may be at higher risk for complications, compared with patients without CL/P. The objective of this study was to evaluate 90-day postoperative complications of Le Fort I osteotomy in patients with CL/P compared with patients without CL/P. The secondary objective was to evaluate differences in reoperation and readmission rates between cohorts.

A retrospective cohort study was conducted using the PearlDiver Mariner national database. Inclusion criteria were patients older than or equal to 12 years of age who underwent Le Fort I osteotomy between the years 2010 and 2022. Exclusion criteria were patients with craniofacial syndromes or those who underwent concomitant mandibular osteotomy. The primary outcome was 90-day complications. Secondary outcomes were reoperation and readmission rates.

A total of 7053 patients were included, and 717 (10.2%) had an associated CL/P diagnosis. Patients in the CL/P group had higher risk of surgical site infection (OR: 1.20; 95% CI: 1.00-1.42, P=0.046), hardware removal (OR: 3.43; 95% CI: 2.81-4.19; P<0.001), revision Le Fort I osteotomy (OR: 2.68; 95% CI: 1.61-4.35; P<0.001), and readmission (OR: 3.20; 95% CI: 1.59-6.18; P<0.001).

Patients with CL/P had a significantly higher risk of postoperative infection, reoperation, and readmission than patients without CL/P. These results highlight the elevated postoperative risk profile for patients with CL/P. Furthermore, there is a need to develop perioperative protocols to minimize preventable complications and improve outcomes for patients with CL/P undergoing Le Fort I osteotomy.