The purpose of this study was to investigate the amount and pattern of postsurgical relapse after 2-jaw surgery in cleft lip and palate patients in terms of the sagittal and vertical aspects. The samples consisted of 21 adult patients who had the similar initial skeletodental pattern before surgery and underwent 2-jaw surgery. They were divided into high relapse (n = 11) and low relapse groups (n = 10) (criteria, 30% forward relapse of the B point). After the cephalometric variables of cephalograms taken at 1 month before surgery (T0), immediately after surgery (T1), and at least 1 year after surgery (T2) were measured, the Wilcoxon test, Mann-Whitney U test, and Pearson correlation test were performed for statistical analysis. When compared with the low relapse group, the high relapse group exhibited significant counterclockwise rotation of the distal segment of the mandible resulting in more forward movement of the mandible and significant labioversion of the maxillary incisors during T1-T2. The amount of postsurgical relapse of the mandible had a positive relationship with the amounts of setback and clockwise rotation of the mandible with surgery. In addition, the more decrease in overbite through surgery occurred, the more relapse (forward movement of the mandible) produced. Therefore, for the prevention of significant postsurgical relapse of the mandible in cleft patients, it is necessary to reduce unnecessary clockwise rotation of the mandible and to increase the vertical stability of maxilla during orthognathic surgery.

The purpose of this study was to investigate three-dimensional facial soft tissue changes after bimaxillary orthognathic surgery (BOGS) in patients with cleft lip and palate. The samples consisted of 34 Korean young adult patients with skeletal class III malocclusion who underwent BOGS for maxillary advancement/ posterior impaction and mandibular setback. They were divided into cleft-class III (C-CIII) group (n ¼ 18) and noncleft-class III (NC-CIII) group (n ¼ 16). Three-dimensional computed tomography images were taken 1 month before (T1) and 3 months after (T2) surgery. After 34 hard/soft tissue landmarks were automatically identified using software, the amount and direction of change in landmarks and the amount of change in 16 soft tissue variables during T1-T2 were calculated. Then, statistical analysis was performed. Compared to NC-CIII group, C-CIII group showed more posteriorly-positioned hard/soft tissue landmarks, larger alar width, alar base width and philtrum width, and more obtuse nasal tip angle at both T1 and T2 stages. C-CIII group exhibited higher soft-to-hard tissue movement ratios at the bottom of the nose (DSn/DANS, 1.08 versus 0.81) and the upper part of the upper lip (DPoint A'/DPoint A, 1.08 versus 0.91), but a lower ratio at the lower part of the upper lip (DLs'/DIs, 0.72 versus 1.01) than NC-CIII group. The number of hard-soft tissue landmarks with high correlation (>0.90) was smaller in C-CIII group than in NC-CIII group (2 versus 6). Scar tissues and abnormal muscles in the nose and upper lip might elicit different responses in the nasolabial soft tissues to BOGS between C-CIII and NC-CIII patients.

The purpose of this study was to investigate the effect of secondary alveolar bone grafting (SABG) on the maxillary growth in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP). The samples consisted of 40 Korean boy cleft patients who had the similar initial skeletal characteristics and were treated with the identical treatment protocol. They were divided into UCLP group (N = 25; mean SABG age, 9.9 years; mean follow-up duration, 42.3 months) and BCLP group (N = 15; mean SABG age, 10.2 years; mean follow-up duration, 40.6 months). In the lateral cephalograms taken 1 month before (T1) and at least 2 years after SABG (T2), cephalometric variables were measured. At T1 stage, the 2 groups did not exhibit significant differences in the cephalometric variables except posterior maxillary height (P-HRP) (P < 0.05). At T2 stage, both groups exhibited the reduced sagittal growth (UCLP, ANB, P < 0.001; AB to facial plane angle (AB-FPA), P < 0.01; BCLP, A to N perpendicular, P < 0.05; ANB and AB-FPA, P < 0.001) and the undisturbed vertical growth (A-HRP and P-HRP, all P < 0.001) of the maxilla. During T1 to T2, BCLP group experienced more aggravation of Class III skeletal pattern than UCLP group (ΔAB-FPA, P < 0.05). There, however, were no differences in the amounts of changes in the maxillary vertical position and mandibular plane angulation between the 2 groups. Two-stage SABG procedure subgroup in patients with BCLP demonstrated a more retrusive maxilla compared with 1-stage SABG procedure subgroup (ΔSNA, P < 0.05). Patients with BCLP, especially who underwent 2-stage SABG procedure, might have a possibility of poor sagittal growth of the maxilla compared with patients having UCLP.

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