Considerations for Presurgical Orthodontic Treatment & Surgical Planning According to Diverse Skeletal Phenotypes in Cleft Patients

The purposes of this presentation are (1) to explain how many percentages of cleft patients would turn into candidates for surgical intervention after completion of growth, (2) to enumerate the three-dimensional characteristics of diverse skeletal phenotypes in cleft patients who were treated with orthognathic surgery (OGS), (3) to discuss the strategic considerations for presurgical orthodontic treatment and surgical planning for cleft patients according to their skeletal phenotypes, and (4) to describe the causes and prevention of post-surgical relapse in cleft patients.

The speaker's clinical study results were as follows: (1) Despite long-term use of facemask therapy with miniplates (FM-MP), 1/3 of unilateral cleft lip and palate (UCLP) patients became candidates for OGS. After completion of the pubertal growth peak, the frequency of OGS candidates increased with cleft severity [cleft lip and alveolus (CLA), 8.5%; UCLP, 21.4%; bilateral CLP (BCLP), 30.0%, P<0.05]. (2) According to cluster analysis, the AP phenotypes of UCLP and BCLP patients were classified into 3 groups: severely retrusive maxilla and moderately retrusive mandible group (61.8%), moderately retrusive maxilla and normal mandible group (30.9%), and normal maxilla and moderately protrusive mandible group (7.4%). The facial asymmetry (FA) phenotypes in UCLP patients were classified into 3 groups: symmetry (30.8%), Cant and Deviation to the cleft-side (36.5%), and Cant and Deviation to the noncleft-side (32.7%). (3) According to these results, strategic decompensation by pre-surgical orthodontic treatment and considerations for OGS planning according to the AP and FA phenotypes and the causes and prevention of post-surgical relapse in cleft patients will be explained with a series of cases.