Three-Dimensional Outcome Assessments of Surgical Correction in Cleft and Noncleft Patients with Class III Skeletal Relation: A Case-Control Study

Abstract

Background. The orthognathic strategies to treat patients with a concave profile but different tissue conditions remain controversial. The aim of this case-control study was to investigate the outcome predictability of orthognathic surgery in cleft lip and palate (CLP) patients and matched controls. Methods. Fifty consecutive CLP and 45 matched non-CLP patients who received whole-piece Le Fort I and bilateral sagittal split osteotomy to correct class III skeletal relations were enrolled. The outcome discrepancies (ODs) from simulations among all groups were evaluated with consideration of the possible influences from planned surgical movements (PSM). Receiver operating characteristic curves were used to determine threshold values of PSMs that yielded clinically relevant OD. Results. Unilateral CLP (UCLP) patients had comparable postsurgical OD to non-CLP patients in both jaws, whereas bilateral CLP (BCLP) patients had greater deviations from predicted results. Vertical movement of the $\text{A}-\text{point}>1.33\text{mm}$ and $\text{yaw}\text{correction}>{1.65}^{°}$ in the BCLP patients was associated with clinically relevant maxillary OD. Conclusions. The OGS outcomes of BCLP patients were less predictable than those of the UCLP and noncleft patients. Vertical movements of the $\text{A}-\text{point}>1.33\text{mm}$ and $\text{yaw}\text{correction}>{1.65}^{°}$ in BCLP patients increased OD to a clinically relevant extent.