Purpose: LeFort I osteotomy is used to correct and improve the maxillary hypoplasia in secondary cleft deformities. However, surgical complex and challenge would be the risk factor of postsurgical instability. This study compared surgical and postsurgical changes in maxillary and mandibular movements and stability in patients with cleft lip and palate (CLP) who underwent single- or two-piece LeFort I osteotomies.
Materials and Methods: Forty-five patients with CLP were included, of whom 30 and 15 received single- and two-piece LeFort I osteotomies, respectively. Cone-beam computed tomography was administered at three time points (T0: presurgery; T1: <1-month postsurgery; and T2: ≥1-year postsurgery) to evaluate surgical (T1–T0) and postsurgical (T2–T1) changes in maxillary and mandibular movement and stability. The overall movement, arch width, and relapse rate were measured and compared between the groups. Potential factors influencing skeletal stability were surgical change, segmental maxilla, cleft types, age, sex, and prior alveolar bone graft placement were analyzed.
Results: There revealed a significant difference in maxillary relapse between the 2 groups in the sagittal plane. The two-piece group had a higher relapse rate than did the single-piece group across all planes. No significant difference between maxillary expansion and constriction was observed in the two-piece group. In maxilla, surgical change influenced all dimensions of surgical relapse, and surgical approach, which involved single- and two-piece procedures, influenced only the sagittal plane (P < 0.05). In mandible, only surgical change influenced mandibular relapse in the three planes; other factors did not reveal any significant correlation.
Conclusion: The outcome indicated that the two-piece group had more maxillary sagittal relapse after surgery. Surgical change was the main factor influencing maxillary and mandibular stability. Sagittal overcorrection might be required for patients with two-piece LeFort I advancement in patients with cleft.
Jittithaworn, Chanin; Chang, Chun-Shin; Huang, Chiung Shing; Lin, Cheng-Hui; and Ko, Ellen Wen-Ching
"Comparing Outcomes and Stability after Single- and Two-piece LeFort I Osteotomies in Patients with Cleft Lip and Palate,"
Taiwanese Journal of Orthodontics: Vol. 33:
4, Article 2.
https://doi.org/10.38209/2708-2636.1115 Available at: https://www.tjo.org.tw/tjo/vol33/iss4/2
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