Frequency of Surgical Correction for Maxillary Hypoplasia in Cleft Lip and Palate Snehlata Oberoi, DDS,* William Y. Hoffman, DDS,Þ Radhika Chigurupati, DMD,þ and Karin Vargervik, DDS§ Objective: The aim of this study was to determine the frequen- cy of surgical correction of maxillary hypoplasia in individuals with nonsyndromic cleft lip and/or palate (CL/P) treated at the Center for Craniofacial Anomalies at University of California, San Francisco (UCSF). Subjects: This is a retrospective cohort study of individuals with cleft lip and/or palate born between 1970 and 1990 who were treated at the UCSF Center for Craniofacial Anomalies. Data were gathered from the UCSF Craniofacial Anomalies Filemaker Pro database. Methods: From the database, we collected the following infor- mation: age, gender, cleft type, date of orthognathic surgery, and type of osteotomy. The subjects were further subcategorized by cleft type and gender. Results: A total of 973 individuals with a diagnosis of cleft lip and/or palate were reviewed: 325 subjects had an associated syndrome and 648 were nonsyndromic. A total of 59 of these 648 nonsyndromic cleft individuals (9.1%) required surgical intervention for correction of maxillary hypoplasia: 2/105 (1.9%) for cleft lip, 4/122 (3.3%) for cleft palate, 35/286 (12.2%) for unilateral cleft lip and palate, and 18/135 (13.3%) for bilateral cleft lip and palate. Conclusions: The frequency of surgical correction for maxillary hypoplasia in cleft individuals at UCSF Center for Craniofacial Anomalies at 9% was lower than the reported average of 25%. Key Words: Cleft lip/palate, maxillary hypoplasia, Le Fort (J Craniofac Surg 2012;23: 1665Y1667) C left lip and/or cleft palate constitute the most common con- genital malformation of the head and neck. 1 Many individuals with a cleft develop maxillary hypoplasia, which includes features such as concave facial profile, lack of adequate upper lip support and nasal tip projection, decreased upper incisor display, and an- terior and posterior crossbites. 2 Clinical studies of maxillary growth associated with a cleft have yielded conflicting results. This may be due to study limitations such as small sample size, large age range, different clinical management protocols, failure to separate cleft types, combining of sexes, inade- quate controls, and insufficient postoperative interval. Some 3Y5 claim that maxillary deficiency in cleft individuals is an intrinsic primary defect. Others 6Y8 maintain that the maxillary deficiency is primarily a result of surgical repair. Some investigators have tried to determine whether it is lip or palate repair that causes deficient maxillary growth. Capelozza et al 8 found maxillary retrusion after lip repair only and those who had both lip and palate repair did not differ significantly from the lip repair-only group. Other authors have stated that it is the repair of the palate that most interferes with normal maxillary growth. 7,9Y11 Maxillary growths in unilateral cleft lip and palate have been studied in various age groups. In children younger than 8 years, findings vary from predominantly normal 12Y14 to smaller than normal maxillae. 15Y16 However, most studies have found smaller than normal anterior-posterior dimensions, indicating maxillary hypoplasia in individuals older than 11 years. 17Y21 One study reported no difference from normal. 22 However, it is generally agreed that maxillary growth is often diminished in individuals with repaired cleft lip and/or palate and that this is due to a combination of intrinsic skeletal, dental, and soft tissue deficiencies and the subsequent effects of surgical and other interventions. The maxillary deficiency is in vertical, anterior- posterior, and transverse dimensions, and its severity varies due to many factors such as cleft type, timing, and type of interventions and of interceptive treatment. When the degree of maxillary hypoplasia is severe, surgical correction with facial osteotomies is necessary. Typi- cally, a Le Fort I maxillary procedure is used to correct this deformity in adolescence, after growth completion. The literature indicates that the need for surgical correction ranges between 14% and 45% with an average of 25%. The aim of this study is to determine the frequency of maxillary hypoplasia requiring surgical correction in individuals with non- syndromic cleft lip and/or palate (CL/P) treated at the UCSF Center for Craniofacial Anomalies. METHODS This retrospective cohort study was conducted on individuals with nonsyndromic cleft lip and/or palate that had completed growth; born between 1970 and 1990. Data were gathered from the UCSF Craniofacial Anomalies Filemaker Pro 10.0 database (Santa Clara, CA). Key words used were cleft lip (CL), cleft palate (CP), cleft lip and palate (CLP), unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP), and bilateral cleft ORIGINAL ARTICLE The Journal of Craniofacial Surgery & Volume 23, Number 6, November 2012 1665 What Is This Box? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code links to the online version of the article. From the *Center for Craniofacial Anomalies, School of Dentistry, the †Department of Surgery, School of Medicine, University of California at San Francisco, the ‡Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, and the §Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco. Received May 31, 2012. Accepted for publication June 15, 2012. Address correspondence and reprint requests to Snehlata Oberoi, DDS, Division of Craniofacial Anomalies, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143-044; E-mail: sneha.oberoi@ucsf.edu The authors report no conflicts of interest. Copyright * 2012 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e31826542ff Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.