Background Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and
palate, for whom functional recovery and aesthetic improvement after surgery are important.
The aim of this study was to examine maxillary and mandibular changes, along with
concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy
and sagittal split ramus osteotomy (two-jaw surgery).
Methods Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and
November 2013 were included. Cephalometric analysis was conducted before and after
surgery. Preoperative and postoperative measurements of the bone and soft tissue were
compared.
Results The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that
of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was
-4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle
was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance
between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm
after surgery. The ratio of soft tissue change to bone change was 0.55 between point
A and point A' and 0.93 between point B and point B'.
Conclusions Patients with cleft lip and palate who underwent two-jaw surgery showed optimal
soft tissue changes. The position of the soft tissue (point A') was shifted by a distance
equal to 55% of the change in the maxillary bone. Therefore, bone surgery without
soft tissue correction can achieve good aesthetic results.
Keywords
LeFort osteotomy - Sagittal split ramus osteotomy - Cleft lip and palate - Orthognathic
surgery
