Predictors of Reoperation After Orthognathic Surgery in Patients With Cleft Palate: Two Decades of Insight

Orthognathic surgery represents a critical intervention within the continuum of care for patients with cleft lip and palate (CLP). Postoperative relapse is a significant complication and often necessitates reoperation. This study assesses risk factors for reoperation due to relapse following cleft orthognathic surgery. A retrospective review was conducted of patients with CLP who underwent orthognathic surgery for correction of class III malocclusion between 2005 and 2024, excluding those with under 6 months of follow-up. Maxillary advancement techniques included surgically assisted maxillary protraction (SAMP), LeFort I advancement (LF1), and distraction osteogenesis (DO). The outcome of interest was reoperation for late relapse. Overall, 133 patients met the inclusion criteria. The median age at surgery was 18.4 years, and the median follow-up was 2.1 years. Sixteen patients (12.0%) underwent SAMP, 101 (76.9%) LF1, 7 (5.3%) DO, and 9 (6.8%) staged DO followed by LF1. Bilateral sagittal split osteotomy (BSSO) for mandibular setback was performed in 48.4%. The incidence of reoperation was 13.5%. Maxillary advancements >8.5 mm were 6.3 times more likely to require reoperation ( P <0.001). Multivariable regression identified bilateral CLP ( P =0.038) and multiple prior maxillary operations ( P =0.009) as significant predictors of reoperation, while BSSO was associated with decreased odds of reoperation ( P =0.027). Patients with bilateral CLP and multiple prior maxillary operations were significantly more likely to require reoperation for late relapse. Limiting sagittal movements to <8.5 mm or performing concurrent BSSO may mitigate the risk of reoperation.