title: Incidence of Le Fort Surgery in a Mature Cohort of Patients With Cleft Lip and Palate.
abstract: Primary repair of cleft lip and palate occurs early in life, but ideal timing of these interventions remains controversial. Prior research has indicated that a later palate repair may improve patients' midfacial growth long term, whereas optimal timing of lip repair to maximize midfacial growth has not been identified.The purpose of this study is to analyze a large, diverse cohort of patients with cleft lip and palate to determine whether timing of primary palate repair and primary lip repair contributed significantly to subsequent orthognathic surgery.
  
  
  METHODS
  Seventy-one nonsyndromic patients with cleft lip and/or palate were followed until age 23 years, and data regarding original diagnosis, surgical procedures, and dates were collected. Within our patient cohort, 12 patients (16.9%) underwent orthognathic surgery. Binary logistic regressions, Fisher exact tests, and Mann-Whitney U tests were used to determine whether timing of primary palate repair and primary lip repair contributed significantly to subsequent orthognathic surgery.
  
  
  RESULTS
  In our cohort, the association of early lip repair with later orthognathic surgery trended toward significance (P = 0.080). Timing of primary palate repair was not significantly associated with later orthognathic surgery (P= 0.291). When correcting for sex, race, diagnosis, location of care, incidence of lip adhesions, and incidence of lip revisions, patient age at primary lip procedure was a significant predictor of later orthognathic surgery (P = 0.041).
  
  
  CONCLUSIONS
  Inconsistent with prior research, age at primary palate repair in our cohort was not correlated with incidence of orthognathic surgery. Delayed primary lip repair was associated with a significant decrease in the rate of subsequent orthognathic surgery.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA; †Division of Plastic Surgery, University of Massachusetts Memorial, Worcester, MA; and ‡Division of Genetics and Dysmorphology, Rady Children's Hospital San Diego, San Diego, CA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Dalle Ore
authors.forename: Anna
authors.initials: A
authors.lastname: Schoenbrunner
authors.forename: Michael
authors.initials: M
authors.lastname: Brandel
authors.forename: Nicola
authors.initials: N
authors.lastname: Kronstadt
authors.forename: Joyce
authors.initials: J
authors.lastname: McIntyre
authors.forename: Marilyn
authors.initials: M
authors.lastname: Jones
authors.forename: Amanda
authors.initials: A
authors.lastname: Gosman
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D056948:Orthognathic Surgical Procedures; D019340:Osteotomy, Le Fort / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult