Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine.
J Craniofac Surg. 2022;33(1):87-92. doi: 10.1097/SCS.0000000000008002.
To determine the true need for orthognathic surgery in patients with repaired cleft lip and/or palate (CL/P) at a high-volume craniofacial center.
An institutional retrospective review of patients with CL/P born between 1975 and 2008 was performed. Patients with adequate documentation reflecting cleft care who were ≥ 18 years at the time of last craniofacial/dentistry follow-up were included. Patients with non-paramedian clefts or a comorbid craniofacial syndrome were excluded. Primary outcome variable was the total proportion of patients with CL/P who either underwent or were referred for orthognathic surgery Le Fort I (LF1) to correct midface hypoplasia. Secondary outcome variables were associations between cleft phenotype, midface hypoplasia severity, and number of cleft related surgeries with the eventual LF1 referral/recipiency.
One hundred seventy-seven patients with CL/P met inclusion criteria. A total of 90/177 (51%) patients underwent corrective LF1; however, 110/177 (62%) of patients were referred for surgery. Patients with secondary cleft palate involvement were referred for and underwent LF1 at significantly greater rates than those without secondary palate involvement (referred: 65% versus 13%, P = 0.001; underwent: 55% versus 0%, P < 0.001). Patients with bilateral cleft lip/palate were referred for and underwent LF1 at significantly higher rates than those with unilateral cleft lip/palate (referred: 71.0% versus 50.4%, P= 0.04; underwent: 84% versus 71%, P = 0.02). Number of secondary palate surgeries was positively correlated with increased LF1 referral (P = 0.02) but not LF1 recipiency (P = 0.15).
The incidence of orthognathic surgery redundant in patients with repaired CL/P was 51% at our institution, marginally above the higher end of previously reported rates. However, this number is an underrepresentation of the true requirement for LF1 as 62% of patients were referred for surgical intervention of midface hypoplasia. This distinction should be considered when counseling families.
在高容量颅面中心确定接受过唇腭裂（CL/P）修复的患者真正需要接受正颌手术的情况。
对 1975 年至 2008 年间出生的 CL/P 患者进行机构回顾性研究。纳入具有足够反映唇腭裂治疗情况的记录且最后一次颅面/牙科随访时≥18 岁的患者。排除非中央性唇裂或伴有颅面综合征的患者。主要结局变量是 CL/P 患者中接受或转介接受 Le Fort I（LF1）手术以矫正中面部发育不全的总比例。次要结局变量是唇裂表型、中面部发育不全的严重程度和与 LF1 转介/接受相关的手术数量与最终 LF1 转介/接受之间的关系。
177 例 CL/P 患者符合纳入标准。共有 90/177（51%）例患者接受了矫正 LF1；然而，110/177（62%）例患者被转介进行手术。伴有继发腭裂的患者被转介接受 LF1 的比例明显高于无继发腭裂的患者（转介：65%比 13%，P=0.001；接受：55%比 0%，P<0.001）。双侧唇腭裂患者被转介接受 LF1 的比例明显高于单侧唇腭裂患者（转介：71.0%比 50.4%，P=0.04；接受：84%比 71%，P=0.02）。继发腭裂手术的数量与 LF1 转介的增加呈正相关（P=0.02），但与 LF1 接受的增加无关（P=0.15）。
在我们的机构中，接受过修复的 CL/P 患者接受正颌手术的发生率为 51%，略高于之前报道的较高水平。然而，这一数字是 LF1 真正需求的一个低估，因为 62%的患者被转介接受中面部发育不全的手术干预。在为患者提供咨询时，应该考虑到这一区别。
