Comparing the socio-economic and emotional implications of management of a hypoplastic cleft maxilla with distraction osteogenesis or orthognathic surgery in a developing country

Abstract

Management of a hypoplastic maxilla can be addressed through distraction osteogenesis (DO) or orthognathic surgery (OS), with DO being preferred for severe deformity due to the increased stability of its long-term outcomes. This study aims to compare the economic and emotional implications of DO versus OS at an Indian institute. A total of 20 patients who underwent maxillary DO were compared with 20 patients who underwent orthognathic Le Fort I osteotomy. Sourced from the GSR Institute of Craniofacial Surgery database, patients completed a telephone questionnaire, via a translator, which investigated: return travel costs to hospital, length of hospital stay, Likert scales gauging mood and impact on daily life before, during, and after treatment. There was a marked increased mean length of hospital stay associated with rigid external device (RED) in comparison with OS by 70.5%. This is also associated with a greater mean total cost of hospital stay per patient, also by 70.5%. The mean number of visits to hospital postoperatively was over twice the number of visits for RED in comparison with OS, associated with a staggering 859.9% increase in financial burden on RED patients compared with OS with regards to mean total return travel costs to hospital. There was a 36.8% percentage change in impact on daily life scores for RED patients compared with 25.0% percentage change associated with OS. While DO appears advantageous, its economic drawbacks emphasise the necessity for a comprehensive evaluation of clinical and economic outcomes in low-resource settings. Limitations included challenges due to various regional languages and absence of pre-existing maxillary deficiency data.