title: Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients.
abstract: BACKGROUND
  Orthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery).
  
  
  METHODS
  Twenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared.
  
  
  RESULTS
  The mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'.
  
  
  CONCLUSIONS
  Patients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Yung Sang
authors.initials: YS
authors.lastname: Yun
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Ki Il
authors.initials: KI
authors.lastname: Uhm
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jee Nam
authors.initials: JN
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Dong Hyeok
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyun Gon
authors.initials: HG
authors.lastname: Choi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Korea.
authors.forename: Soon Heum
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Korea.
authors.forename: Cheol Keun
authors.initials: CK
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Chungju, Korea.
authors.forename: Dong In
authors.initials: DI
authors.lastname: Jo
keywords: Cleft lip and palate; LeFort osteotomy; Orthognathic surgery; Sagittal split ramus osteotomy