**4. Residual deformities in CLP patients**

Patients with Isolated Cleft Palate (ICP) have a complete alveolar ridge and generally a complete set of teeth [13, 17, 26, 27]. The main deformity in unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients is maxillary hypoplasia, but oronasal fistula, bony defects, intranasal obstruction, soft tissue scarring, and velopharyngeal dysfunctions are also frequently encountered [27]. Additionally, the maxillary lateral incisor and often the second premolars in the cleft region are either congenitally missing, resulting in a cleft-dental gap [6, 28–30].

In addition to the existing deformities in UCLP and BCLP patients, nasal obstruction and sinus blockage and mandibular asymmetry and chin dysplasia are seen frequently as secondary deformities [27, 31]. The prevalence of these deformities varies significantly based on the surgical philosophy and experience of the surgeon who repaired the first cleft [32], the individual's unique biological growth potential, and the level of care of the family/patient.

Published clinical research on individuals who were born with complete UCLP/ BCLP and treated at cleft centers showed that, despite the best efforts, the mixed dentition period would not be appropriate for grafting just before the canine tooth is erupted on the cleft side in some children [33, 34]. Additionally, although grafted appropriately, in some individuals, additional reconstruction is needed [33]. For these reasons, repairing residual skeletal and soft tissues and managing dental deformities in patients with CLP strains the proficiency and skills of the orthognathic surgery cleft team [26, 31, 35].
