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Predicting the Need for Orthognathic Surgery in Patients with Cleft Lip and/or Palate
Adam Henrie BS, Jessica Lee MD, Jonathan Lee, MD, Ali Ayyash MPH, Matthew Ford CCC-SLP, Lindsay Schuster DMD, MS, Joseph Losee, MD, Jesse Goldstein, MD
University of Pittsburgh
2018-02-15
Presenter: Ali Maher Ayyash
Affidavit:
Ali M. Ayyash
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Children born with cleft lip and/or palate (CLP) are at risk for developing class III malocclusion which may require orthognathic surgery at skeletal maturity. The significance of the total number and type of cleft-related surgical interventions as predictive factors for orthognathic surgery is not fully understood.
Methods: A case-control study was conducted at our institution among non-syndromic patients born with CLP after 1993 who had reached skeletal maturity. Cases were patients with CLP who underwent or required orthognathic surgery, and controls were those who did not require orthognathic surgery. Interventions were reviewed to predict the need for orthognathic surgery.
Results: 78 cases were compared to 100 controls. Patients who required orthognathic surgery had significantly more interventions than patients who did not (mean 5.5 surgeries versus 3.5, p < 0.0001, Mann-Whitney U). Number of interventions was a significant predictor of requiring orthognathic surgery with an approximate 51% increase in odds for every additional intervention (p < 0.0001, logistic regression). Further analysis showed alveolar bone graft (p < 0.0001) to be a significant predictor, likely a marker for cleft severity. Oronasal fistula repair (p=0.099), revision palatoplasty (p=0.095), and cleft lip adhesion (p=0.086) trended towards an association with needing orthognathic
surgery but not at a statistically significant level.
Conclusions: The total number and type of interventions prior to skeletal maturity are significant predictors for orthognathic surgery. Understanding the importance of these factors can help guide the clinical decision-making process in the care of children born with CLP.
