The Need for Orthognathic Surgery in Patients with Repaired Complete Unilateral and Complete Bilateral Cleft Lip and Palate

Abstract

Objective: To determine the percentage of patients with complete unilateral cleft lip and palate and complete bilateral cleft lip and palate treated at SickKids since birth who would benefit from orthognathic surgery. Design: Retrospective cohort study. Subjects: The review comprised records of 258 patients with complete unilateral cleft lip and palate and 149 patients with complete bilateral cleft lip and palate born from 1960 to 1989. Of these, 211 and 129 patients, respectively, had been treated at SickKids since birth. Patients with syndromes or associated anomalies were excluded. Methods: Patients who had undergone orthognathic surgery were recorded. For the remaining patients, arbitrarily set cephalometric criteria were used in order to identify the “objective” need for surgery. Lateral cephalometric radiographs taken beyond the age of 15 years were digitized using Dentofacial Planner cephalometric software. Results: Of the 211 patients with complete unilateral cleft lip and palate, 102 (48.3%) were deemed to benefit from orthognathic surgery. For the complete bilateral cleft lip and palate sample, the percentage was 65.1% (84 of 129). Definitive information on presurgical orthopedics was available for a small subsample (101 patients) of the complete unilateral cleft lip and palate cohort. The need for orthognathic surgery for this group was slightly higher (59.4%, or 60 of 101). Conclusion: These results suggest that a considerable percentage of patients with a history of complete cleft lip and palate at our institution require orthognathic surgery. Factors that need to be considered in the interpretation of these results include the quest for improvement in the profile aesthetics; the fact that the Canadian health care system covers the costs of surgery, making it more accessible to the patients; and the inclusion in the above figures of patients who had orthognathic surgery solely for reasons of closure of previously ungrafted alveolar clefts and associated fistulae.