Factors influencing the decision for orthognathic surgery in cleft palate patients

In the complex rehabilitation of patients with cleft lip and palate, a secondary surgical correction is often necessary at the end of the growth period in order to optimize the skeletal jaw position. The aim of this study was to retrospectively identify those factors in the initial diagnosis, treatment approaches and findings at the time of decision-making, which statistically describe the assignment of patients to a group receiving only orthodontic treatment and to a group receiving surgical correction of the jaw position. The study assessed the findings and analyses of 55 adult patients with non syndromic cleft (38 who received orthognathic surgery at the end and 17 who only received orthodontic treatment). The 25 parameters, collected for the initial cleft formation, the treatment concept and the timing of the bone graft, also included additio al parameters from ceph lometrics and dental cast analysis. A total of 1,210 items of the 55 patients were evaluated using a classification algorithm (CART analysis). The target was to identify the parameters that were responsible for assigning the patients to the specified groups. As expected, both groups differed significantly in various parameters. However, an overbite depth indicator (ODI) of 73.7° can be interpreted as the threshold influencing assignment to the respective group. The probability that the patients who received orthognathic surgery were correctly assigned was 90% in contrast to all other parameters. As a result, the ODI is a simple value which could be used to estimate the likelihood that a secondary surgical correction in cleft patients is needed. 1 Department of Orthodontics, University Leipzig, Germany 2 Department of Maxillofacial, Plastic and Reconstructive Surgery, University Leipzig, Germany