**2. Timing of orthognathic surgery**

In the past, CLP-orthognathic surgery in the mixed dentition period has been discussed and discarded. It has been reported that there will usually be a need for revisions after completion of skeletal growth [10]. Risks of early orthognathic surgery include damage to permanent tooth germs and creation of fibrous tissue and calli in the osteotomy regions. Additionally, it was shown that neither Le Fort I osteotomy nor distraction osteogenesis in the mixed dentition period provides additional lateral maxillary growth [11, 12]. Apart from cases with significant psychosocial or functional problems, risks of "early" surgery overweigh its benefits [13].

Orthognathic surgery for treatment of maxillomandibular deformities is usually applied after completion of growth of the maxillomandibular structure [14–16]. Transverse, sagittal, and vertical growth of the maxilla and the mandible ends at different chronological ages, usually at the ages of 14–16 for female patients and 16–18 for male patients [17]. Mandibular growth has a normal pattern in most CLP patients [13]. However, since skeletal growth is variable, hand-wrist or cephalometric radiographs may help in determining the timing of skeletal maturation [17].
