Evaluation of Orbitomalar Region Projection İn Patients With Operated Cleft Lip and Palate Part 2: Effect of Maxillary Position

Objective To evaluate the impact of maxillary position on orbitomalar and suborbital projection by comparing patients with and without cleft with normal and retrusive maxilla, and to determine whether projection loss is primarily related to cleft pathology or maxillary retrusion. Design Retrospective comparative cephalometric study. Setting Single tertiary orthodontic center; records from 2010 to 2015. Patients A total of 142 patients (74 with cleft, 68 without cleft) aged 7 to 13 years, meeting defined inclusion criteria. Patients were divided into 4 groups according to cleft status and maxillary AP position determined by SNA: retrusive maxilla with cleft (RCMx, n = 44), normal maxilla with cleft (NCMx, n = 30), retrusive maxilla without cleft (RMx, n = 28), and normal maxilla without cleft (NMx, n = 40). Interventions No intervention was performed. Main Outcome Measures Linear orbitomalar projection measurements (LOr-VP, IOr-VP, AOr-VP, SbOr1-VP, SbOr2-VP) and maxillary position parameters (SNA, ANS-VP, A-VP). Group comparisons and correlation analyses were performed using non-parametric statistics. Results Significant intergroup differences were observed for all orbitomalar and suborbital projection measurements ( P < .05). Patients with retrusive maxilla, regardless of cleft status, demonstrated lower orbital and suborbital projection values compared with those with normal maxillary position. Suborbital parameters showed the largest variation between groups. Moderate-to-strong positive correlations were found between maxillary anterior development (SNA, ANS-VP, A-VP) and orbitomalar projection. Conclusion Maxillary retrusion, rather than cleft status, appears to be a key determinant of reduced orbitomalar projection and midfacial convexity. In patients with retrusive maxilla, correction of midfacial deficiency may require consideration of infraorbital and zygomatic support in addition to maxillary advancement.