Analysis of surgical timing and treatment patterns in patients with cleft lip and palate using Korean Health Insurance Review and Assessment Service (HIRA) big data.

In cleft lip and palate (CLP), the long-term impacts of surgical timing, use of presurgical orthopaedic appliances, and cleft extent on craniofacial growth remain debated. Claims data from the Korean Health Insurance Review and Assessment Service were leveraged to perform a retrospective analysis based on diagnostic and procedure codes. The study included 23,401 patients aged <40 years treated between 2007 and 2023. The surgical timing, cleft type and extent, use of presurgical orthopaedic appliances, and their associations with maxillary growth-related interventions, revision procedures, otitis media, and tympanostomy tube insertion were evaluated. Overall, 53.03% of the patients underwent cleft-related surgeries. Most cleft lip (CL) repair, cleft palate (CP) repair, and primary rhinoplasty were performed before age 2 years. Early CL surgery (<2 years) was associated with higher rates of orthodontic treatment (P = 0.007) and palatal expansion (P < 0.001), and early CP surgery (<2 years) with an increased frequency of orthognathic surgery (P < 0.001). These findings indicate associations that may reflect the influence of surgical timing on maxillary growth. Compared to CL alone, orthodontic treatment, arch expansion, and orthognathic surgery were more frequent with CP involvement (all P < 0.001). Presurgical orthopaedic appliance use was associated with reduced revision surgery (P < 0.001). Incidences of otitis media and tympanostomy tube insertion were higher for clefts involving the soft palate (both P < 0.001). In conclusion, surgical timing, cleft extent, and presurgical orthopaedic appliance use were observed to significantly influence long-term treatment patterns and growth-related sequelae in CLP.