Comparative analysis of soft tissue response after orthognathic surgery in patients with and without cleft using 3D imaging: A preliminary study

This study investigated differences in upper lip soft tissue response to skeletal movement between patients with and without cleft following orthognathic surgery. Twelve patients with Class III dentofacial deformities underwent orthognathic surgery: six with complete unilateral cleft lip and palate and six age- and sex-matched non-cleft controls. Hard tissue movement was measured using 3D surgical simulation, and soft tissue changes were assessed with 3D photogrammetry. The cleft group showed significantly greater advancement across all hard tissue landmarks compared to the non-cleft group (p < 0.01). However, soft tissue advancement at the subnasale was only moderately greater in the cleft group (p < 0.05), with no significant differences observed at other midline points. Soft-to-hard tissue movement ratios were consistently lower in the cleft group, although these differences did not reach statistical significance. The ratio of soft tissue volume change to A-point displacement was higher in the non-cleft group than in the cleft group (p < 0.05), indicating a reduced soft tissue response in the cleft group. These findings suggest that patients with cleft may require greater skeletal advancement to achieve favorable soft tissue outcomes, highlighting the importance of individualized surgical planning to balance aesthetic goals with complications such as velopharyngeal insufficiency.