Managing cleft lip and palate (CLP) requires a delicate balance between functional restoration and preserving facial growth. A recent study highlights that revision cleft surgeries significantly contribute to maxillary hypoplasia, a condition where the upper jaw fails to grow adequately. Surgeons have long suspected that surgical scarring restricts skeletal development. This new evidence quantifies the risks, suggesting that "the first repair is the best" to ensure optimal long-term outcomes.

The Relationship Between Revision Cleft Surgeries and Maxillary Hypoplasia

Researchers analyzed 106 skeletally mature patients using advanced cone-beam CT scans and cephalometric measurements. They found that revision cleft surgeries have a cumulative negative effect on the sella-nasion-A point (SNA) and A point-nasion-B point (ANB) angles. Specifically, each additional revision surgery reduces the maxillary length by approximately 1.31 mm. Consequently, the risk of requiring orthognathic surgery (OGS) increases by 2.7 times for every additional procedure performed before skeletal maturity.

Predictors of Growth Restriction

The morphology of the cleft also plays a critical role in facial development. Patients with bilateral cleft lip and palate (BCLP) exhibited a significantly reduced maxillary width compared to those with unilateral clefts. On average, BCLP patients had a 2.87 mm deficit in maxillary width. Furthermore, patients who underwent four or more cleft-related surgeries were at the highest risk for severe maxillary hypoplasia.

Surgeons must consider that excessive scarring from repeated interventions acts as a physical tether. This restriction limits the natural forward and downward growth of the midface. Therefore, clinical protocols should aim to achieve definitive results in primary repairs whenever possible to minimize the need for secondary revisions.

Conclusion

The study underscores the importance of surgical efficiency. While secondary revisions are sometimes unavoidable, each procedure carries a measurable cost to the patient's skeletal profile. Prioritizing high-quality primary repairs may reduce the long-term burden of orthognathic surgery and improve the overall quality of life for patients with cleft lip and palate.

Frequently Asked Questions

How do revision cleft surgeries affect jaw growth?

Revision surgeries increase surgical scarring, which restricts the forward and transverse growth of the maxilla. This often leads to maxillary hypoplasia and a concave facial profile.

What is the risk of needing orthognathic surgery after revisions?

Every additional cleft-related revision surgery performed before the age of 16 increases the likelihood of needing orthognathic surgery by 2.7 times.

Is bilateral cleft palate more severe than unilateral?

Yes, patients with bilateral cleft lip and palate (BCLP) typically show significantly reduced maxillary width compared to unilateral cases, increasing the complexity of long-term management.

Disclaimer: This content is for informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Edgar M et al. First Repair is Best: The Facial Growth Consequences of Revision Cleft Surgeries. Plast Reconstr Surg. 2026 Mar 04. doi: 10.1097/PRS.0000000000012985. PMID: 41780061.


2. Kamata M, Sakamoto Y, Ogata H, et al. Influence of Lip Revision Surgery on Facial Growth in Patients With A Cleft Lip. J Craniofac Surg. 2023;34(4):1203-1206. doi:10.1097/SCS.0000000000012981.


3. Farber SJ, Maliha SG, Gonchar MN, et al. Effect on Facial Growth of the Management of Cleft Lip and Palate. Ann Plast Surg. 2019;83(6):e72-e76. doi:10.1097/SAP.0000000000001800.