Title: Premaxillary Setback in Bilateral Cleft Lip and Palate Repair
Abstract: INTRODUCTION: Patients with cleft lip and palate often display facial disproportion secondary to inherent hypoplastic tissues and iatrogenic disruption of the maxilla. Bilateral alveolar clefts may render a protruding premaxilla, distorting the soft tissue envelope. Accordingly, a premaxillary setback (PS) is beneficial during primary lip repair to normalize labial topography. The study evaluated patients undergoing simultaneous PS with primary lip repair and their outcomes to improve cleft care. METHODS: An IRB-approved retrospective review was conducted on patients with bilateral cleft lip ± palate (BCLP) who underwent lip repair ± PS from January 1975 through September 2021. Indications, incidence of midface hypoplasia, orthodontic and/or orthognathic treatments, complications, and perioperative metrics were analyzed. RESULTS: Thirty-one patients with BCLP + PS met inclusion criteria; indications for PS included protuberant, malpositioned, flyaway, protracted, rotated, and/or distracted premaxillas. Midface hypoplasia occurred in two-thirds of patients (21 of 31). Thirty-one BCLP – PS patients were analyzed. Midface hypoplasia occurred in nearly half of patients (15 of 31). There was a significant association between comorbidities and likelihood of developing midface hypoplasia (p = 0.007). Among the two groups, there was no significant difference in the number of patients who developed midface hypoplasia (p = 0.123). CONCLUSION: Although a high incidence of midface hypoplasia was seen in both BCLP ± PS and BCLP – PS, our findings demonstrate no difference in midface hypoplasia irrespective of PS in the setting of BCLP. Future prospective studies investigating the downstream ramifications of our suggested selection criteria for PS are warranted.