Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Do Patients With Cleft Lip and/or Cleft Palate Require More Postoperative Opioids Following Le Fort I Osteotomy?
СтатьяНазвание и аннотация: Перевод в очереди
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Green Mark A, Heo Joseph, Eischeid Carter, Britt Michael C, Cohen Nicholas A, Padwa Bonnie L
Аннотация
BACKGROUND: Le Fort I (LFI) osteotomies in patients with cleft lip and/or palate (CL/P) present unique challenges. It is unclear if these patients require distinct postoperative pain management.
PURPOSE: The purpose of this study was to measure and compare postoperative opioid consumption between patients with and without CL/P undergoing LFI osteotomies.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included patients who underwent LFI osteotomies at Boston Children's Hospital (2015 to 2024). Patients with chronic pain, psychiatric disorder, or developmental delay were excluded.
PREDICTOR VARIABLE: The predictor variable was CL/P status coded as CL/P present or absent.
MAIN OUTCOME VARIABLE: The primary outcome variable was postoperative opioid consumption in morphine milligram equivalents while inpatient. Secondary outcome variables included any opioid use (yes/no) and opioid delivery route (intravenous/oral).
COVARIATES: Covariates included sex, age, magnitude of maxillary advancement, procedure length, ancillary procedures, length of hospital stay, surgeon, and postoperative nausea and/or vomiting.
ANALYSES: χ2 tests, nonparametric tests of medians, independent sample t tests, and the Mann-Whitney U test were used to evaluate sample characteristics. A generalized linear model with a Gamma distribution and log link was used to create an adjusted model. P values <.05 were statistically significant.
RESULTS: A total of 399 subjects (53.9% [n = 215] males) were included with a median age of 19.09 (interquartile range: 17.65 to 20.65) years. The cohort consisted of 44.9% (n = 179) with a history of CL/P, compared to 55.1% (n = 220) without CL/P. Subjects with CL/P required a smaller median dose (milligram morphine equivalents) of total postoperative opioids compared to those without CL/P (6.56 [1.20 to 22.40] vs 13.80 [2.50 to 34.61], P < .001) despite subjects with CL/P having a greater mean magnitude of maxillary advancement (6.79 ± 2.49 vs 5.73 ± 2.22, P < .001). After adjusting for sex, age, procedure length, magnitude of maxillary advancement, ancillary procedures, length of stay, surgeon, and postoperative nausea and/or vomiting, subjects with CL/P displayed a 33% reduction in total opioid requirement compared to subjects without CL/P (mean ratio: 0.67 [0.51 to 0.87], P = .003).
CONCLUSIONS AND RELEVANCE: Patients with CL/P may require fewer opioid analgesics during inpatient recovery following LFI osteotomy compared to patients without CL/P.
PURPOSE: The purpose of this study was to measure and compare postoperative opioid consumption between patients with and without CL/P undergoing LFI osteotomies.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included patients who underwent LFI osteotomies at Boston Children's Hospital (2015 to 2024). Patients with chronic pain, psychiatric disorder, or developmental delay were excluded.
PREDICTOR VARIABLE: The predictor variable was CL/P status coded as CL/P present or absent.
MAIN OUTCOME VARIABLE: The primary outcome variable was postoperative opioid consumption in morphine milligram equivalents while inpatient. Secondary outcome variables included any opioid use (yes/no) and opioid delivery route (intravenous/oral).
COVARIATES: Covariates included sex, age, magnitude of maxillary advancement, procedure length, ancillary procedures, length of hospital stay, surgeon, and postoperative nausea and/or vomiting.
ANALYSES: χ2 tests, nonparametric tests of medians, independent sample t tests, and the Mann-Whitney U test were used to evaluate sample characteristics. A generalized linear model with a Gamma distribution and log link was used to create an adjusted model. P values <.05 were statistically significant.
RESULTS: A total of 399 subjects (53.9% [n = 215] males) were included with a median age of 19.09 (interquartile range: 17.65 to 20.65) years. The cohort consisted of 44.9% (n = 179) with a history of CL/P, compared to 55.1% (n = 220) without CL/P. Subjects with CL/P required a smaller median dose (milligram morphine equivalents) of total postoperative opioids compared to those without CL/P (6.56 [1.20 to 22.40] vs 13.80 [2.50 to 34.61], P < .001) despite subjects with CL/P having a greater mean magnitude of maxillary advancement (6.79 ± 2.49 vs 5.73 ± 2.22, P < .001). After adjusting for sex, age, procedure length, magnitude of maxillary advancement, ancillary procedures, length of stay, surgeon, and postoperative nausea and/or vomiting, subjects with CL/P displayed a 33% reduction in total opioid requirement compared to subjects without CL/P (mean ratio: 0.67 [0.51 to 0.87], P = .003).
CONCLUSIONS AND RELEVANCE: Patients with CL/P may require fewer opioid analgesics during inpatient recovery following LFI osteotomy compared to patients without CL/P.