Determinants of Planned Orthognathic Surgical Movements in a Singaporean Cleft Lip and Palate Cohort

Cleft lip and palate are frequently associated with disturbances in maxillary growth, and many patients require orthognathic surgery at skeletal maturity. This study aimed to characterize baseline craniofacial morphology and determine factors influencing the magnitude of planned orthognathic surgical movements in a Singaporean cleft cohort managed using virtual surgical planning (VSP). A retrospective cohort study was conducted, including non-syndromic cleft patients who underwent orthognathic surgery between 2020 and 2025 at a tertiary cleft center in Singapore. All procedures were planned using VSP and performed with customized cutting guides and fixation plates. Demographic variables, preoperative cephalometric parameters (SNA, SNB), and planned skeletal and dental movements were extracted from surgical planning records. Forty-four patients were included (20 males, 24 females). The median age at surgery was 20.24 years (IQR 19.67-22.46). Male patients underwent surgery at a significantly older age than females (22.21 versus 19.87 y, P < 0.001) and demonstrated greater baseline maxillary retrusion (median SNA 73.05 degrees versus 77.50 degrees, P = 0.007). Planned maxillary advancement was significantly greater in males for both A-point (8.18 ± 2.19 mm versus 5.88 ± 2.05 mm; P < 0.001) and maxillary incisor tip movement (7.55 ± 1.94 mm versus 5.25 ± 2.24 mm, P < 0.001). SNB differed significantly across cleft subtypes (P = 0.005), although the magnitude of planned surgical movements did not differ significantly between cleft phenotypes. These findings suggest that while sex and cleft phenotype influence baseline craniofacial morphology, planned orthognathic surgical movements remain broadly comparable across cleft subtypes within contemporary VSP workflows.