Complications Following Orthognathic Surgery in Patients with Cleft Lip and/or Palate: A single-centre retrospective analysis of 57 consecutive patients.

Abstract

Objectives: The most prevalent craniofacial abnormality in infants is cleft lip and/or palate (CL/P). Orthognathic surgery is necessary for 25-60% of patients in order to enhance face aesthetics and masticatory function. Nevertheless, there is a lack of defined complication profiles in this particular population. Thus, this study aimed to describe the spectrum and frequency of complications following orthognathic surgery in CL/P patients at a tertiary care referral centre.

Methods: This retrospective cohort study included consecutive CL/P patients who underwent orthognathic surgery at Al Nahda Hospital, Muscat, Oman, between 2008-2022. Variables analysed included demographics, procedure type, length of stay and predefined complications (intraoperative haemorrhage, transfusion, dental injury, wound dehiscence, relapse, temporomandibular joint [TMJ] disorder, repeat surgery and condylar resorption). Complications were graded using the Clavien-Dindo Classification (CDC) and 95% Wilson confidence intervals (CI) were calculated.

Results: A total of 57 patients were included in this study. Nearly half of patients underwent Le Fort I osteotomy (45.6%), followed by bimaxillary (31.6%), Le Fort I + genioplasty (10.5%), trimaxillary (8.8%), BSSO (1.8%) and BSSO + genioplasty (1.8%). Overall, 19 patients developed complications, most of which were CDC Grade III. The most frequent complication was relapse (10.5%), followed by TMJ disorder (5.3%), repeat surgery (5.3%), dental injury (3.5%), intraoperative haemorrhage (3.5%), wound dehiscence (1.8%), transfusion (1.8%) and there were no cases of condylar resorption.

Conclusions: Complications developed in one-third of patients who underwent orthognathic surgery; however, most were manageable. Relapses were the most frequent complication and there were no life-threatening complications (CDC Grade IV-V), demonstrating overall safety of the procedure in CL/P patients.