Craniofacial Morphologic Changes and Associated Factors After Combined Orthodontic-Orthognathic Treatment in Patients With Cleft Lip and Palate

OBJECTIVE: To quantify craniofacial morphologic changes after combined orthodontic-orthognathic treatment in patients with cleft lip and palate and to identify factors associated with horizontal relapse at A point after maxillary advancement. METHODS: This retrospective cohort included 186 patients treated from January 2024 to January 2026. Cephalograms were analyzed at presurgical baseline (T0), within 1 week after surgery (T1), and at the last follow-up at least 6 months after surgery (T2). Horizontal relapse at A point was defined as posterior displacement of A point from T1 to T2 on an SN-based coordinate system after cranial-base superimposition. Measurement reliability was assessed in 30 randomly selected patients. Paired analyses quantified T0-to-T2 morphologic change, and multivariable models evaluated relapse magnitude and relapse of 2 mm or greater. RESULTS: The mean age was 20.7 years, 54.8% were male, and the mean follow-up was 14.7 months. From T0 to T2, SNA increased by 4.93 degrees, ANB by 7.12 degrees, Wits appraisal by 6.56 mm, and facial convexity by 8.82 degrees. The mean horizontal relapse at A point was 2.74 mm (95% CI, 2.60-2.89); 150 patients (80.6%) had a relapse of 2 mm or greater. Larger advancement, higher scar score, bilateral cleft phenotype, and segmental maxillary osteotomy were associated with greater relapse. Patient-specific fixation and concurrent bone grafting were associated with lower relapse, but these associations should be interpreted as noncausal. CONCLUSION: Combined orthodontic-orthognathic treatment was associated with sagittal skeletal and profile improvement. Relapse at A point was measurable and was associated with movement magnitude, cleft phenotype, scarring, segmentation, fixation, and bony support. A clear definition of radiographic timing and coordinate-based relapse measurement is essential for interpreting stability after cleft orthognathic surgery.