OBJECTIVES: To examine the quality of life (QoL) and cost of protraction or orthognathic surgery for patients with cleft lip and palate (CLP) and class III malocclusion.

METHODS: Within a prospective cohort study, participants with isolated CLP underwent either protraction or orthognathic surgery for class III malocclusion and reported on QoL at baseline, maximal correction, completion, and 1-year follow-up. QoL was measured using the Short Form Health Survey (SF-12), yielding Physical Component Scores (PSC) and Mental Component Scores (MSC). Costs were gathered from patient’s billing history.

RESULTS: Participants (N=93; 55% male) were 11-21 years old and 53 underwent protraction and 40 had orthognathic surgery. Most participants were Latinx (69%) with public insurance (61%). Patients had unilateral (81%) or bilateral (19%) CLP and had prior cleft-related surgeries (M = 5.1±1.9). Correction of class III malocclusion was seen for 51% of the protraction cohort and 93% of the surgery cohort. Mean SF-12 scores were in the average range and were unrelated with medical or sociodemographic variables. Longitudinally, PCS significantly improved for the whole sample from baseline (M = 51.8±6.8) to post-treatment (M = 54.9±4.3); however, this change was not significant when restricted to those with a successful outcome. Although the baseline MCS was significantly higher (F = 5.37, P = .02) for protraction cohort, there were no significant differences at 1-year follow-up based on cohort or treatment outcome. The total cost of the surgery (M = $112,779) was significantly greater than the cost of the protraction (M = $6,815) with large variation case-by-case. The incremental cost-effectiveness ratio per PCS gain (-$32,806) favored protraction for QoL.

CONCLUSIONS: Patients with CLP and class III malocclusion in this sample had average range QoL that did not vary by treatment approach or outcome. Success was higher in the surgery group, which also had higher costs.