title: Complications following orthognathic surgery for patients with cleft lip/palate: A systematic review.
abstract: OBJECTIVE
  The purpose of this systematic review is to update the available data for complications following orthognathic surgery in cleft lip and/or palate patients.
  
  
  METHODS
  Three electronic databases (Medline, Embase, and Cochrane) were searched for publications from 1990 to 2014.
  
  
  RESULTS
  A total of 26 articles were selected including 1003 patients (male: 391, female: 353, 259: not mentioned) who underwent maxillary osteotomies for cleft lip/palate. Mean age at surgery was 19.3 years (range: 8.5-60 years). Overall perioperative complications were reported in 126 cases (12.76%). The most common complication was closure failure of pre-existing palatal fistula (28.57%), followed by velopharyngeal impairment (16.79%), closure failure of pre-existing alveolar fistula (10.74%), gingival recession (4.55%), and failure of premaxilla stabilization in bilateral cases (4.55%). Severe vascular complications included one arteriovenous fistula (0.10%), one maxillary aneurysm (0.10%), and one cavernous sinus thrombosis (0.10%). Mean horizontal relapse rate was 17.9% (range: -20.0% to 37.2%), and mean vertical relapse rate was 35.4% (range: -25.9% to 162.5%). Reoperation rate was 12.2% (range: 0.0-64.0%). Prospective studies or randomized trials were rare.
  
  
  CONCLUSIONS
  To obtain a dataset with higher evidence, a prospective multicenter study should be conducted with clearly defined criteria for each complication.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lonic
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: lunjoulo@cgmh.org.tw.
authors.forename: Lun-Jou
authors.initials: LJ
authors.lastname: Lo
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D006801:Humans; D063166:Maxillary Osteotomy / Q000009:adverse effects*; D057909:Orthognathic Surgery / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*
keywords: cleft lip; complication; maxillary osteotomy; orthognathic surgery; systematic review