The Role of Personalised Orthognathic Surgery in Cleft Lip and Palate Care

A cleft lip and palate is defined as “a gap or split in the upper lip and/or roof of the mouth” [1]. Present from birth, this condition occurs when a baby’s face does not form properly in the womb, often leading to immediate challenges with eating, hearing, breathing, speech, or dental development.

While initial surgeries are performed early in infancy to reattach tissues using stitches [2], the reconstructive journey often continues into adolescence and adulthood.

As we approach July—National Cleft and Craniofacial Awareness and Prevention Month—it is vital to raise awareness, improve public understanding of these conditions, and highlight the advanced surgical innovations transforming patient lives [3].

The Role of Orthognathic Surgery in Cleft Care

Following initial cleft lip and palate repairs, secondary complications can arise as the patient grows. A frequently observed challenge is the lack of development in the midfacial complex, along with remaining bone defects, nerve damage, and scarring.

An underdeveloped maxilla (upper jawbone) can lead to:

• Difficulty breathing during sleep (obstructive sleep apnea)

• Chronic jaw joint (TMJ) pain

• A severe improper bite (malocclusion)

To remedy these post-surgery side effects, improve quality of life, and ensure long-term airway safety, Orthognathic surgery becomes necessary. When significant jaw misalignment is present, this specialised corrective jaw surgery reorients the skeletal structure—such as moving the underdeveloped maxilla forward and repositioning the mandible (lower jaw) backward—to achieve a balanced, correct bite [4].

A Multidisciplinary Approach: Orthodontics & Oral Surgery

Orthodontic treatment and Orthognathic surgery must go hand-in-hand to ensure optimal outcomes. The patient may receive orthodontic treatment before, after, or before and after orthognathic surgery to correct misalignment of teeth. The exact sequencing of braces or aligners depends entirely on the doctor’s clinical discernment to properly align the teeth before and after jaw repositioning.

Because of this complexity, highly specialised Oral and Maxillofacial Surgery teams work in close coordination with orthodontists, speech therapists, and other craniofacial specialists to deliver comprehensive, well-rounded care [5].

Benefits of Personalisation

Every cleft case presents a completely unique anatomical landscape due to scar tissue and asymmetric bone growth. This is where advanced personalised medical technology completely redefines the surgical experience.

By utilising high-resolution CT scans to create tailored treatment plans, surgeons can bypass traditional "one-size-fits-all" compromises through Virtual Surgical Planning (VSP).

Integrating a custom Patient-Specific Implant and 3D-printed surgical guides delivers profound clinical advantages:

• Less Invasive Procedures: Surgical guides and plates are deliberately engineered to fit precisely onto the target areas of interest. This eliminates the need for large, exploratory incisions, drastically reducing tissue trauma and the risk of post-operative complications.

• Predictable Results: Because a Patient-Specific Implant is contoured exactly to the patient's unique anatomy, intraoperative guesswork is eliminated. Surgeons achieve a highly predictable, stable structural alignment that accelerates recovery times and elevates long-term facial symmetry [6].

Through the collaboration of multidisciplinary expertise and 3D technology, individuals born with a cleft lip and palate can look forward to a future of improved function, clear speech, and confident smiles.

Written by: Pokpon Visahaphanit (Mind)

References

[1] Overview - Cleft lip and palate. NHS.

[2] Cleft Lip & Cleft Palate Surgery: Repair Steps & Post-op Care. Cleveland Clinic.

[3] Announcement: National Cleft and Craniofacial Awareness and Prevention Month — July 2015. Centers for Disease Control and Prevention (CDC).

[4] H. Yilmaz and A. Ari Demirkaya, ‘Orthognathic Surgery in Cleft Lip and Palate Patients’, Current Treatment of Cleft Lip and Palate. IntechOpen, Mar. 25, 2020.

[5] Cunha A, Silveira HMD, Miguel JAM. Clinical guidelines and planning for orthodontic-surgical treatment using clear aligners. Dental Press J Orthod. 2025 Apr 7;30(1):e25spe1.

[6] Kesmez Ö, Valls-Ontañón A, Starch-Jensen T, Haas-Junior OL, Hernández-Alfaro F. Virtual surgical planning in orthognathic surgery with the use of patient-specific plates compared with conventional plates. A systematic review focusing on complications, financial expenses, professional and patient-reported outcome measures. Med Oral Patol Oral Cir Bucal. 2022 Nov 1;27(6):e507-e517.