Comparison of Perioperative and Postoperative Outcomes Following Orthognathic Surgery in Patients With and Without Cleft Lip and/or Palate

BACKGROUND: Orthognathic surgery in patients with cleft lip and/or palate (CLP) presents unique anatomical and surgical challenges. This study compared postoperative complications between cleft and noncleft patients undergoing orthognathic surgery. MATERIAL AND METHODS: A retrospective study at a single tertiary craniofacial center compared patient characteristics and perioperative outcomes between cleft and noncleft patients undergoing orthognathic surgery. RESULTS: A total of 118 procedures in 115 patients (69 CLP, 49 noncleft) were included. Median follow-up was 225.5 days (interquartile range [IQR], 51-702) in the cleft cohort and 100 days (IQR, 1-375) in the noncleft cohort. Cleft lip and/or palate patients more frequently presented with Angle Class III malocclusion (81.2% versus 55.1%, P=0.002), crossbite (43.5% versus 20.4%, P=0.009), and deviated nasal septum (47.8% versus 20.4%, P=0.002), while noncleft patients more commonly presented with mandibular hypoplasia (32.7% versus 14.5%, P=0.019) and Angle Class II malocclusion (26.5% versus 8.7%, P=0.009). Hemifacial/craniofacial microsomia was also more common in the noncleft cohort (12.2% versus 1.4%, P=0.020). Bone graft utilization trended higher in the CLP cohort (56.5% versus 38.8%, P=0.057). Operative time, blood loss, and length of stay were comparable between groups. Skeletal/dental relapse occurred more frequently in the CLP cohort (14.5% versus 0.0%, P=0.005), while overall complications trended higher without reaching significance (33.3% versus 22.4%, P=0.198). On multivariable analysis, cleft status was not independently associated with adverse outcomes. Instead, syndromic status was the most consistent independent predictor of readmission (Firth-penalized OR 6.56, P=0.011), relapse (Firth-penalized OR 8.41, P = 0.004), and overall complications (MLE OR 3.33, P = 0.038; Firth-penalized OR 3.09, P = 0.050). Elevated ASA class (>2) was associated with overall complications on univariable analysis but did not remain independently predictive after adjustment (OR 1.84, P=0.314). CONCLUSIONS: Within this single-center cohort, syndromic diagnosis and medical complexity, rather than cleft status alone, were the principal correlates of adverse outcomes. These exploratory findings support risk stratification that prioritizes syndromic and systemic factors in orthognathic surgery.