Purpose: this study aims to provide and suggest a difficulty index or score for anticipated challenges in orthognathic surgeries for the CL/P patient.

Methods: This was a retrospective study, done by collecting data of orthognathic surgeries performed on CL/P patients in the period from December 2020 to March 2022. Patients included were those with retrognathic or hypoplastic maxilla, that had a history of cleft lip, cleft palate or both, and had either failed or skipped alveolar bone grafting, with or without oronasal fistulae, and had undergone LF-1 osteotomy to advance the maxilla. Proper description of the clinical and radiographic findings was collected for each patient, along with the subjective score and any occurring difficulties reported by the surgeon at the time of the surgery. An objective score was formulated and statistically correlated with the subjective score.

Results: Patients included in this study summed up to be 9 patients. The subjects were 44% males with age range of 16 to 21 years. 78% had cleft lip with palate, and 22% were cleft lip only, with primary palate. Various difficulties were reported by the surgeon in each patient, with wide range of subjective scores. Spearman correlation showed a positive correlation of 0.866 between the subjective score and the proposed difficulty index.

Conclusion: The proposed difficulty index proved to be a promising tool, permitting better planning and preparation in the future of these surgeries. More validation is required with studies of bigger sample size.