Journal of Cranio-Maxillofacial Surgery最新文献

{"title":"Groningen TMJ total joint replacement prosthesis: 3 to 7-year follow-up on surgical and patient reported outcomes.","authors":"Bram B J Merema, Nico B van Bakelen, Carrol P Saridin, Joep Kraeima, Fred K L Spijkervet","doi":"10.1016/j.jcms.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.008","url":null,"abstract":"<p><p>A prosthetic total joint replacement (TJR) may be indicated for patients who suffer from severe dysfunction or resorption of the temporomandibular joint (TMJ). Currently, the patient-specific or custom TMJ-TJR prosthesis options are plentiful. However, there is a lack of thorough (long term) follow-up studies. The aim of this prospective study was to assess the 3 to 7-year follow-up outcomes of the patient-specific Groningen temporomandibular joint total joint replacement (G-TMJ-TJR) prosthesis (Xilloc Medical®, Geleen, the Netherlands). Longitudinal assessments of surgical outcomes, changes in maximum interincisal opening (MIO), laterotrusion, protrusion and patient reported outcomes (PROMs) on functional mandibular impairment (MFIQ) and pain (VAS) were studied. These outcomes were collected preoperatively, and 6, 12 and 24 months postoperatively for all included patients, while MIO, VAS pain and MFIQ were reported till up to 60 months postoperatively. Fourteen patients (13 female, 1 male) who had received a patient-specific G-TMJ-TJR, with a minimum follow-up period of 24 months, were included. The average age at implantation was 53.7 (sd 11.3) years. A patient-specific G-TMJ-TJR prosthesis was successfully implanted in all 14 patients without any mechanical failures or adverse effects during the minimum 2-year follow-up (mean 57 months) period. All G-TMJ-TJR devices were accurately implanted according to the 3D-VSP. There were no post-operative infections but temporary weakness of a facial nerve branch was reported by two patients. The median MIO increased from 19.5 to 30.0 mm, while the median VAS pain (R: 0-10) score reduced from 7.2 to 0.9 cm. The median MFIQ (R: 0-68) diminished from 47.0 to 9. Pain was relieved by the G-TMJ-TJR prosthesis in all but one patient with chronic pain. Protrusion and laterotrusion to both sides increased, indicating more freedom of movement in the operated joint and resulting in a more natural jaw movement. This study shows considerable functional improvement compared to a prior follow up of a former G-TMJ-TJR study. This indicates that thorough 3D planning, subsequent patient-specific modelling, and accurate guided placement of the G-TMJ-TJR improves clinical outcomes significantly.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The skull base in NF1 phenotypes on lateral cephalograms.","authors":"Enno K Lilienthal, Hannah T Scheuer, Hanna A Scheuer, Reinhard E Friedrich","doi":"10.1016/j.jcms.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.011","url":null,"abstract":"<p><p>Neurofibromatosis type 1 (NF1) influences skeletal growth processes. We investigated the effect of the disease and associated neurogenic craniofacial tumors on the skull base. We examined skull base parameters on lateral cephalograms in patients with (N = 74) facial plexiform neurofibroma (FPNF) and 92 without and the same number of age- and sex-matched controls. The measurements were analyzed for mean differences and certain parameters (sex, age (< or ≥ 18 years), tumor type). The application of the skull base angle as a diagnostic parameter was explored. We found statistically significant elongation of the anterior and a shortening of the posterior skull base, as well as an increase of the skull base angle in NF1 patients compared with controls. The effect sizes of comparisons varied in strength. The effect of tumor type in NF1 patients on the parameter was revealed in adults. NF1 and especially FPNF affect the development of the skull base. The changes in the posterior skull base may indicate the beginning of a continuum of posterior skull base dysplasia, as has been repeatedly described in NF1. However, differences in the measurements were small. The skull base relationships do not provide a skeletal basis defining a proposed pathognomonic NF1 facies.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower face widening in mandibular osteotomies: Is the increase in osseous and cutaneous bigonial distance correlated with mandibular advancement?","authors":"Guillaume Santoni, Thomas Schouman, Jean-Baptiste Caruhel","doi":"10.1016/j.jcms.2025.09.016","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.016","url":null,"abstract":"<p><p>Mandibular osteotomies are known to widen the mandibular angles by increasing the bigonial distance (BGD). Previous studies have highlighted the relationship between the extent of mandibular movement and the increase in BGD, both for cutaneous bigonial distance (CBGD) and osseous bigonial distance (OBGD). However, the relationship between changes in OBGD, CBGD and mandibular advancement remains to be fully established. The aim of this study was to compare changes in OBGD and CBGD using adapted three-dimensional examination techniques in patients who underwent mandibular osteotomies. Preoperative and postoperative computed tomography scans and stereophotogrammetry were used to measure mandibular advancement, OBGD and CBGD before and after surgery. Of the 77 patients included, 93.5 % underwent bilateral sagittal split osteotomy, and 79.2 % had received patient-specific guided surgery. Of these, 53 patients had mandibular advancement and 24 underwent mandibular setback. In all cases, a significant increase in both OBGD and CBGD was found after surgery. The extent of mandibular advancement was significantly associated with a greater increase in both OBGD and CBGD.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative biomechanical analysis of three rapid maxillary expanders in BCLP patients: A three-dimensional finite element study.","authors":"Shuoyi Hui, Jianing Liu, Yanqi Zhang, Qiang Ning, Fang Jin, Lei Wang","doi":"10.1016/j.jcms.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.002","url":null,"abstract":"<p><p>Maxillary expansion in bilateral complete cleft lip and palate (BCLP) poses unique biomechanical challenges due to disrupted anatomy and scarred sutures. This finite element study compared three expander types-conventional Hyrax, pre-positioned Hyrax, and fan-shaped-in a patient-specific BCLP model derived from CBCT data. We evaluated 3D dentoalveolar displacement, craniofacial suture strain, and periodontal ligament (PDL) stress. The fan-shaped expander achieved greater anterior expansion and vertical control but induced higher von Mises stress and buccal tipping, raising concerns over periodontal safety. In contrast, conventional and pre-positioned Hyrax expanders produced more uniform force distribution and better posterior anchorage control. Skeletal displacement patterns were comparable across models. The findings suggest that fan-shaped expanders may be beneficial for cases with severe anterior constriction but require caution due to stress concentration risks, while Hyrax variants offer biomechanically safer alternatives for moderate expansion needs. This study provides novel, evidence-based insight into expander selection in complex cleft patients and emphasizes the importance of individualized, morphology-driven appliance design.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and application of submental island \"kiss flap\".","authors":"Lin Wang, Meng Wang, Fengzhi Liu, Dongpo Li, Yubo Wei, Shuangyi Wang, Xiurong Chen","doi":"10.1016/j.jcms.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.014","url":null,"abstract":"<p><p>This study aimed to investigate the clinical effects of the kiss flap and the conventional submental island flap for reconstruction after tongue cancer resection. From March 2023 to March 2025, 60 patients with T2-T4 tongue cancer underwent surgical resection. Of these, 16 patients underwent kiss flap reconstruction, and 44 underwent conventional submental island flap reconstruction. The patients were divided into two groups (kiss flap group and conventional flap group) using a double-blind method. The recovery times for speech, swallowing, tongue movement, and donor site complications were evaluated at the 6-month follow-up. SPSS 26.0 software was used for statistical analysis. There was no significant difference in speech intelligibility between the two groups (clarity: p = 0.717; acceptability: p = 0.823). However, the recovery of swallowing function in the kiss flap group was significantly better than that in the conventional flap group (MTF grade good: p = 0.021; acceptable: p = 0.002). Regarding tension at the donor site, the tension of the kiss flap was significantly lower than that of the conventional flap. Kiss flap repair provides tissue volume to the tongue and preserves its movement, speech intelligibility, and swallowing ability. The limitations of this study, including the unbalanced sample size and short follow-up period, along with the need for long-term aesthetic and functional assessments, are acknowledged and discussed in detail. The kiss flap needs further improvement to reduce complications and enhance patients' quality of life. This study lays a foundation for such further improvement.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relations between local bone density from computed tomography and bone regeneration in alveolar cleft repair.","authors":"Guang Zhang, Siqi Wei, Qingqing Li, Tianyi Gu, Yongqian Wang","doi":"10.1016/j.jcms.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.013","url":null,"abstract":"<p><p>Numerous factors influence postoperative bone regeneration with autologous iliac bone grafting in alveolar cleft repair. However, few studies have reported the relationship between preoperative local bone quality and postoperative bone regeneration. Local bone density (BD) was determined according to the gray value in preoperative computed tomography (CT) images with 3D reconstruction technique. Postoperative bone formation volume (BFV) and preoperative bone defect volume (BDV) were obtained after 3D reconstruction, fitting alignment, and Boolean operation based on preoperative and postoperative CT images. The bone formation rate (BFR) was subsequently calculated (BFV/BDV). 12 patients were included in this retrospective study. The mean BD was 658.34 ± 73.40 HU, the mean BFV was 404.89 ± 164.93 mm³ and the mean BFR was 46.1 ± 12.18 % after a follow-up of at least 6 months. Pearson correlation analysis showed that there was a significant positive correlation between the BFV and the BD (r = 0.7815, p = 0.0027), and the BFR and the BD were also significantly positively correlated (r = 0.6533, p = 0.0213). In conclusion, Postoperative BFV and BFR in patients with alveolar cleft who underwent autogenous iliac bone grafting were positively correlated with BD of recipient site.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pro-apoptotic effects of 5-fluorouracil on ameloblastoma in vitro: Exploring the potential of topical 5-FU ointment in adjunctive therapy.","authors":"Zhengrui Zhu, Jie Wang, Jing-Rui Yi, Yinfu Che, Qiwen Man","doi":"10.1016/j.jcms.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.009","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the pro-apoptotic effects of 5-fluorouracil (5-FU) on ameloblastoma (AM) through in vitro experiments and to explore its potential as a topical adjunctive therapy following surgery.</p><p><strong>Methods: </strong>Primary AM cells and freshly resected tumor tissues were treated with 5 μM 5-FU for 48 h. Apoptotic changes were assessed via transmission electron microscopy (TEM), TUNEL staining, and flow cytometry. Cell proliferation and viability were evaluated using EdU incorporation and CCK-8 assays. Transcriptomic profiling and Gene Ontology (GO) enrichment analyses were conducted to investigate underlying mechanisms.</p><p><strong>Results: </strong>5-FU treatment markedly induced apoptosis in AM tissues and cells. TEM revealed abundant apoptotic bodies, with a mean count 2.01-fold higher than controls (p < 0.05). TUNEL staining demonstrated a 2.66-fold increase in apoptotic area (p < 0.01). Flow cytometry showed a 4.70-fold rise in early apoptotic cells (Annexin V⁺/PI^-) and a 25.5 % decrease in viable cells (Annexin V^-/PI^-) (p < 0.01 and p < 0.05, respectively). EdU incorporation decreased by 35.0 %, and CCK-8 assays indicated a 34.5 % reduction in cell viability (p < 0.01). Transcriptomic analysis revealed downregulation of cell cycle-related genes (CCNB1, CCNB2) and enrichment of pathways involved in cell cycle arrest and apoptosis.</p><p><strong>Conclusion: </strong>5-FU effectively induces apoptosis and inhibits proliferation in AM cells, likely through disruption of cell cycle progression. These findings support the potential use of topical 5-FU as an adjunctive pharmacologic strategy in the post-surgical management of ameloblastoma.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning approach to predict surgical site infection in head and neck squamous cell carcinoma patients after free flap reconstruction.","authors":"Hanchen Zhou, Chuning Luo, Qiaoshi Xu, Chong Wang, Bo Li, Delong Li, Huan Liu, Hao Wang, Chang Liu, Jingrui Li, Teng Ma, Fen Liu, Zhien Feng","doi":"10.1016/j.jcms.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.010","url":null,"abstract":"<p><p>Head and neck squamous cell carcinoma (HNSCC) patients undergoing free flap reconstruction face a high risk of surgical site infection (SSI). Logistic regression (LR) models for SSI prediction are limited by linear assumptions, while machine learning (ML) approaches like random forest (RF) may offer superior performance by handling complex clinical data. This study aimed to identify SSI risk factors and compare the predictive performance of LR and RF models. This retrospective study included 442 HNSCC patients. Two predictive models were constructed based on LR and RF methods, respectively. The predictive performance of two models was assessed based on area under the receiver operator characteristic curves, calibration curve, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) was applied in the RF model to analyze the impact of features on prediction results. The RF model outperformed LR, achieving higher accuracy, sensitivity, specificity, and AUC. Calibration curves indicated superior alignment of RF predictions with observed outcomes. DCA revealed higher net benefits for RF across a wide probability threshold range. SHAP analysis identified PNI, operation time, and NLR as top predictors. Novel systemic markers (PNI, NLR) and clinical factors are critical for risk stratification.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skeletal maturation in patients with cleft lip and palate and normal population analyzed by CVM analysis and the fusion of sphenooccipital synchondrosis.","authors":"Qianchuan Ding, Jiangling Sun, Huan He, Haijian Zhu, Binjie Xie, Hongchao Feng, Reinhard E Friedrich","doi":"10.1016/j.jcms.2025.08.007","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.08.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The Cervical Vertebral Maturation(CVM) of normal population and cleft lip and palate population was measured by cone beam computed tomography (CBCT). The fusion of sphenooccipital synchondrosis(SOS)was staged, and the correlation between CVM and SOS fusion staging was analyzed. The reliability of CVM in the diagnosis of SOS joint staging provides some reference for clinical evaluation of the growth and development stage of patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;100 patients with cleft lip and palate and 100 normal people were randomly selected from January 2020 to December 2023 in Guiyang Stomatological Hospital. There were 121 males and 79 females. The CBCT data of patients were imported into Dolphin software to complete three-dimensional reconstruction and CVM measurement as well as SOS fusion for staging. The experimental results were statistically analyzed by software SPSS25 0.0. The correlation between CVM and SOS fusion staging was analyzed by Spearman analysis. The reliability of CVM diagnosis of SOS fusion staging was calculated by positive likelihood ratio (PositiveLikelihoodRatio,LR+).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Spearman rank correlation analysis was used to analyze the consistency of CVM and SOS fusion staging. The results are as follows: 1. The correlation between CVM staging and SOS fusion staging and age was studied in normal group A: male group and female group. The results showed that the two staging methods were highly correlated. The Spearman rank correlation coefficient between CVM staging and SOS fusion stage was 0.922. (p &lt; 0. 01). The correlation coefficient of Spearman grade between SOS fusion degree and age was 0. 842 (p &lt; 0 0.01). 2. Group B: the correlation coefficient of Spearman grade between CVM stage and age was 0.781 (p &lt; 0 0.01). The correlation coefficient of Spearman grade between the fusion degree of SOS and age was 0.765 (p &lt; 0 0.01). Study on the reliability of CVM in the diagnosis of cranial base suture maturity: in group A, CVM1 could diagnose SOS fusion stage 1, CVM2 could diagnose SOS fusion stage 2, CVM3 could diagnose SOS fusion degree 3, CVM4 could diagnose SOS fusion degree 4, while in group B, CVM2 diagnosed SOS fusion stage 3, CVM3 and CVM4 diagnosed SOS fusion stage 4. It can be seen that the degree of CVM and SOS fusion in group B is later than that in group A.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CVM staging and SOS fusion staging in cleft lip and palate patients were later than those in normal subjects. In normal people and cleft lip and palate people, CVM stage was highly correlated with the degree of SOS fusion, and gradually fused with the increase of age, female SOS fusion earlier than male.In the normal population, there is a clear correlation between CVM (Cervical Vertebral Maturation) stages and the fusion stages of the spheno-occipital synchondrosis. This standardized diagnostic criterion provides important clinical reference for determining orthodonti","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palate-first versus lip-first surgical repair sequence in unilateral cleft lip, alveolus, and palate: A retrospective cephalometric comparison of maxillary growth at 5-year follow-up.","authors":"Puneet Batra, Karoon Agrawal, Dhruv Ahuja, Anne Marie Kuijpers-Jagtman","doi":"10.1016/j.jcms.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.jcms.2025.09.001","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of a palate-first surgical approach on maxillofacial morphology in unilateral cleft lip, alveolus, and palate (UCLP) patients compared to the conventional lip-first sequence.</p><p><strong>Subjects: </strong>and Method: This retrospective cross-sectional cephalometric study included two groups of 25 non-syndromic UCLP patients. Group 1 underwent palate repair at 6-9 months, followed by lip, alveolus, and anterior palate repair with primary nasal correction after 3-6 months. Group 2 had lip, alveolus, and anterior palate repair at 3-6 months, with palate repair at 6-18 months. Lateral cephalograms taken at least five years post-second surgery were analyzed. Cephalometric variables between groups were compared using two-sample T-tests.</p><p><strong>Results: </strong>No significant differences were found in S-N-SS, PM-SS, S-PM, N-SP, S-N-Pg, NSL-ML, and ILS-NL. Only maxillary base inclination (NSL-NL) (p < 0.05) was significantly different between groups (mean difference 1.29°; p = 0.003), indicating a relatively antero-inferior maxillary tip in the palate first approach.</p><p><strong>Conclusions: </strong>In UCLP, the cleft repair protocol prioritizing palate repair at 6 months before lip repair at 9 months or later compared to conventional lip repair followed palate repair did not show significant differences in midfacial growth within the first 5 years postoperatively. However, given that pubertal growth trajectories were not captured, long-term studies are warranted to evaluate potential effects. Considering the potential to reduce treatment dropout rates in low- and middle-income countries, the palate-first approach may still be considered for broader application.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}