Palate-first versus lip-first surgical repair sequence in unilateral cleft lip, alveolus, and palate: A retrospective cephalometric comparison of maxillary growth at 5-year follow-up.

Objective
To assess the effect of a palate-first surgical approach on maxillofacial morphology in unilateral cleft lip, alveolus, and palate (UCLP) patients compared to the conventional lip-first sequence.Subjects
and Method: This retrospective cross-sectional cephalometric study included two groups of 25 non-syndromic UCLP patients. Group 1 underwent palate repair at 6-9 months, followed by lip, alveolus, and anterior palate repair with primary nasal correction after 3-6 months. Group 2 had lip, alveolus, and anterior palate repair at 3-6 months, with palate repair at 6-18 months. Lateral cephalograms taken at least five years post-second surgery were analyzed. Cephalometric variables between groups were compared using two-sample T-tests.Results
No significant differences were found in S-N-SS, PM-SS, S-PM, N-SP, S-N-Pg, NSL-ML, and ILS-NL. Only maxillary base inclination (NSL-NL) (p < 0.05) was significantly different between groups (mean difference 1.29°; p = 0.003), indicating a relatively antero-inferior maxillary tip in the palate first approach.Conclusions
In UCLP, the cleft repair protocol prioritizing palate repair at 6 months before lip repair at 9 months or later compared to conventional lip repair followed palate repair did not show significant differences in midfacial growth within the first 5 years postoperatively. However, given that pubertal growth trajectories were not captured, long-term studies are warranted to evaluate potential effects. Considering the potential to reduce treatment dropout rates in low- and middle-income countries, the palate-first approach may still be considered for broader application.