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Comparison of stability and outcomes of surgery-first bimaxillary surgery for skeletal class III deformity between unilateral and bilateral cleft lip and palate

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Abstract

Objectives

Some adults with cleft lip and palate (CLP) require orthognathic surgery due to skeletal deformity. This prospective study aimed to (1) compare skeletal stability following bimaxillary surgery for correction of class III deformity between patients with unilateral CLP (UCLP) and bilateral CLP (BCLP), and (2) identify risk factors of stability.

Materials and methods

Adults with CLP and skeletal class III deformities who underwent surgery-first bimaxillary surgery were divided into two groups according to cleft type: UCLP (n = 30) and BCLP (n = 30). Skeletal stability was assessed with measures from cone beam computed tomography images of the maxilla and mandible taken before treatment, 1-week and ≥ 1 year postsurgery for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch); multiple regression analysis examined risk factors.

Results

At follow-up, the maxilla moved upwards in both groups, and backwards in the UCLP group. The mandible moved forward and upward, shifted to the cleft (deviated) side, and rotated upward in both groups. The amount of surgical advancement was a risk factor for sagittal stability in the maxilla (ß = −0.14, p < 0.05). The mandible had three risk factors for sagittal stability: age (ß = −0.23, p < 0.05), surgical team (ß = −1.83, p < 0.05), and amount of surgical setback (ß = −0.32, p = 0.001).

Conclusions

Two years after bimaxillary surgery, patients with UCLP had a higher sagittal relapse of the maxilla compared with patients with BCLP, which was due to a greater surgical advancement in the patients with UCLP.

Clinical relevance

Surgery-first bimaxillary surgery results in favorable treatment outcomes for correction of cleft-related class III deformity. Severity of jaw discrepancy and surgeons should be considered in the surgical design of overcorrection.

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Funding

The work was supported by the Chang Gung Memorial Hospital, Taiwan (CMRPG5I0022, CMRP5K0181).

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Authors and Affiliations

  1. Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan

    Sutthinee Ruschasetkul, Yu-Fang Liao & Yu-Ray Chen

  2. Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, No. 123, Dinghu Road, Guishan District, Taoyuan City, 333, Taiwan

    Yu-Fang Liao

  3. Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan

    Yu-Fang Liao, Chun-Shin Chang, Ting-Chen Lu, Ying-An Chen, Chuan-Fong Yao & Yu-Ray Chen

  4. Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Yu-Fang Liao, Chun-Shin Chang, Ting-Chen Lu, Ying-An Chen, Chuan-Fong Yao & Yu-Ray Chen

  5. Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

    Chun-Shin Chang, Ting-Chen Lu, Ying-An Chen, Chuan-Fong Yao & Yu-Ray Chen

  6. Craniofacial Center, Taipei Medical University Hospital, Taipei, Taiwan

    Philip Kuo-Ting Chen

Authors
  1. Sutthinee Ruschasetkul
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  2. Yu-Fang Liao
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  7. Philip Kuo-Ting Chen
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Correspondence to Yu-Fang Liao.

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The authors declare no competing interests.

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and was approved by the Institutional Review Board (IRB) and Medical Ethics Committee at Chang Gung Memorial Hospital, Taiwan.

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Informed consent was obtained from all individual participants included in the study.

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Ruschasetkul, S., Liao, YF., Chang, CS. et al. Comparison of stability and outcomes of surgery-first bimaxillary surgery for skeletal class III deformity between unilateral and bilateral cleft lip and palate. Clin Oral Invest 26, 3665–3677 (2022). https://doi.org/10.1007/s00784-021-04336-2

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  • DOI: https://doi.org/10.1007/s00784-021-04336-2

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