Clinical and Statistical Examination of Orthognathic Surgery in Patients with Cleft Lip and Palate During the Past 40 years in Our Department

• Published in: Journal of Japanese Cleft Palate Association Vol. 49; no. 3; pp. 209 - 217
• Main Authors: OKAWACHI, Takako, NOZOE, Etsuro, TADA, Ryohei, KAMIKURI, Yuhei, KIMURA, Namiko, ISHIHATA, Kiyohide, KIBE, Toshiro, TEZUKA, Masahiro, NAKAMURA, Norifumi, NISHIHARA, Kazuhide, MIYAWAKI, Shouichi, SHIIGI, Ayano
• Format: Journal Article
• Language: Japanese
• Published: Japanese Cleft Palate Association 2024; 一般社団法人 日本口蓋裂学会
• Subjects: cleft lip and palate; clinicostatistical observation; Le Fort I osteotomy; Le Fort I型骨切り術; orthognathic surgery; sagittal splitting ramus osteotomy; 下顎矢状分割術; 口唇口蓋裂; 臨床統計; 顎矯正手術
• ISSN: 0386-5185; 2186-5701
• DOI: 10.11224/cleftpalate.49.209

Clinical and statistical observations were made on 91 patients with cleft lip and palate （CLP patients） who underwent orthognathic surgery between 1981 and 2020 at the Department of Oral and Maxillofacial Surgery, Kagoshima University Hospital, and compared to 410 patients with jaw deformities without CLP （non-CLP patients）. The results were as follows. 　1. The male-to-female ratio of CLP patients was 1.1：1, with no gender difference, and the average age was 17.5 years. In contrast, the male-to-female ratio of non-CLP patients was 1：2.4, and the average age was 22.2 years. 　2. Regarding the number of CLP patients by clinical diagnosis, mandibular prognathism was observed in 37 cases （40.7 %）, the combination of mandibular prognathism and maxillary retrognathism in 31 cases（34.1 %）, and maxillary retrognathism in 18 cases（19.8 %）. On the other hand, in non-CLP patients, mandibular prognathism was observed in 352 cases（85.9 %）, the combination of mandibular prognathism and maxillary retrognathism in 24 cases（5.9 %）, and maxillary retrognathism in 9 cases（2.2 %）. Patients with CLP tended to have a higher rate of maxillary retrognathism. 　3. Regarding the number of CLP patients by procedure, sagittal split ramus osteotomy （SSRO） was performed in 37 cases（40.7 %）, the combination of Le Fort I osteotomy and SSRO in 31 cases（34.1 %）, and Le Fort I osteotomy in 16 cases（17.6 %）. On the other hand, in non-CLP patients, SSRO was performed in 344cases（83.9 %）, the combination of Le Fort I osteotomy and SSRO in 34 cases（8.4 %）, and Le Fort I osteotomy in 7 cases（1.7 %）. Patients with CLP tended to have a higher rate of Le Fort I osteotomy. 　4. In CLP patients, the average duration of surgery was 5 hours and 28 minutes and blood loss was 383 g. In non-CLP patients, the average duration of surgery was 4 hours and 20 minutes and blood loss was 255 g. 　CLP patients had significantly longer operative times and more blood loss than non-CLP patients. In particular, blood loss was 3.1 times higher for maxillary single operations. These results suggest that orthognathic jaw surgery in patients with CLP may take longer and be more invasive than in non-CLP patients. Thus, it is considered more important to study and pass on surgical techniques in orthognathic surgery for CLP patients.