Predicting the need for orthognathic surgery in cleft patients: A systematic review

Objectives

A systematic review was performed to determine the predictive factors for orthognathic surgery in the cleft population.

Materials & methods

A systematic search was made in Cochrane, Embase, Pubmed, Scopus, Web of Science and Google Scholar based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search terms focus on the variables or factors that are associated with or predictive for the later need for orthognathic surgery in patients with cleft lip &/or palate (CLP). Clinical studies published from inception until July 2024 were included. Full text of potentially relevant studies were retrieved and independently examined by two reviewers.

Results

A total of 296 articles were identified. Eighteen studies were eligible for final inclusion. Out of the 1345 patients, unilateral CLP was the most common cleft subtype (64.0 %). All were retrospective in nature and the quality of most studies was moderate. Due to the heterogeneity of the studies, a meta-analysis could not be performed. Factors that were significantly associated with indication for future orthognathic surgery in cleft children were categorised into a) iatrogenic, b) intrinsic and c) cephalometric-based variables. Amongst all the factors in these 3 categories, a lower ANB angle was the most widely mentioned predictive factor for subsequent OGS in CLP patients. The age at which such prediction was derived, ranged from 5 to 11 years old.

Conclusion

Although further well-controlled studies are needed to better provide clinicians with predictive factors of the need for cleft orthognathic surgery, both intrinsic and iatrogenic factors have been shown to influence the overall maxillofacial growth in CLP patients.