Differences in the stability of the lesser and greater maxillary segments after cleft orthognathic surgery: A retrospective study using 3D analysis

Stability of maxilla after segmental Le Fort I osteotomy combined with anterior maxilla clockwise rotation in patients with maxillary hypoplasia: a retrospective study

BACKGROUND

Segmental Le Fort I osteotomy combined with anterior maxillary clockwise rotation has been proposed as an effective treatment for maxillary hypoplasia. However, the stability of maxilla after the operation remains unknown.

METHODS

A total of 30 patients undergoing segmental Le Fort I osteotomy were retrospectively included. The follow-up period was more than one year. The stability of anterior maxilla after clockwise rotation was evaluated by cone beam computed tomography (CBCT) performed before surgery (T0), three days after surgery (T1), and at least one year after surgery (T2), respectively. The key parameters were the postoperative relapse of the anterior maxillary clockwise rotation angle (CRA) and paranasal advancement.

RESULTS

Following segmental Le Fort I osteotomy, the average CRA of the anterior maxilla was 10.02° ± 3.86°, while the mean paranasal advancement was 6.22 ± 1.40 mm. At the one-year follow-up, the relapse of CRA and paranasal advancement were -0.42° ± 2.51° (p = 0.951) and -0.28 ± 0.83 mm (p = 0.08), respectively, suggesting good postoperative stability. Additionally, no significant correlation was found between the intraoperative CRA and its relapse over time.

CONCLUSION

Segmental Le Fort I osteotomy combined with anterior maxillary clockwise rotation demonstrates favorable stability up to one year postoperatively, making it a reliable approach for the treatment of maxillary hypoplasia.

Three-dimensional Analysis of Skeletal Stability in Cleft Lip and Palate Patients Undergoing Bimaxillary Surgery With Le Fort I Osteotomy and Intraoral Vertical Ramus Osteotomy

Orthognathic surgery in patients with lip and palate clefts is challenging owing to scar tissue from primary repairs and severe deformities. In this study, we evaluated the stability of Le Fort I osteotomy with intraoral vertical ramus osteotomy (IVRO) in patients with cleft lip and palate using 3-dimensional (3D) analysis. This retrospective study comprised 14 cleft lip and palate patients (3 females, 11 males; the average age at surgery: 23.8 y) who underwent bimaxillary orthognathic surgery involving Lefort I osteotomy and IVRO. Cone-beam computed tomography (CBCT) images were obtained at preoperative (T0), 1-month postoperative (T1), and 1-year follow-up (T2) periods. The 3D analysis assessed the transitions and rotations of the maxilla and mandible using a virtual triangle. The maxilla showed stability in all directions at the 1-year follow-up with minimal relapse. The distal segment of the mandible exhibited clinically acceptable anterior (1.15 mm relapse) movements and pitch rotation (2.88° counterclockwise relapse) during the first year postoperatively. The proximal mandibular segment underwent anterior-inferior transition (1.21 and 2.01 mm, respectively) and lateral-outward rotation (4.90° and 7.51°, respectively) postsurgery, remaining unchanged 1 year postoperation. Le Fort I osteotomy with IVRO provides skeletal stability in patients with cleft lips and palates. This study demonstrated a minimal maxillary relapse and clinically acceptable movements in the distal mandibular segment during the first postoperative year. The proximal mandibular segment moved anteriorly and inferiorly, rotated laterally and outward after surgery, and remained unchanged at the 1-year follow-up.

Reshaping Faces, Redefining Risks: A Systematic Review of Orthognathic Surgery Outcomes in Cleft Lip and Palate Patients

Background: This study aims to determine a generalized outcome and risk profile for patients undergoing orthognathic surgery for the definitive treatment of cleft lip and palate. Furthermore, we hope to determine the key risk factors that cause increased risk for cleft lip and palate patients undergoing orthognathic surgery. Methods: This study includes a systematic review using PubMed, MEDLINE, Cochrane, and Scopus. Data curation utilized Covidence software, with dual-reviewer screening and conflict resolution by a third party, focusing on publications with the full texts available. Results: The initial search yielded 1697 articles. Following title, abstract, and full-text screening, a total of 62 articles were included in this review. A total of 70.9% of included articles had moderate bias, with the rest having low risk of bias. The sample consisted of 2550 patients with an average age of about 20 years and an average follow-up of 16.8 months. The most employed procedure was Le Fort I osteotomy (99%). In terms of velopharyngeal function, there were notable increases in insufficiency and severity scores, with an average 63% worsening score from the baseline. That being said, patients experienced an average 33% improvement in speech articulation. Furthermore, the average horizontal movement was reported to be 6.09 mm with a subsequent relapse of 0.98 mm overall. Conclusions: This systematic review distills data from 62 articles and 2550 patients. It highlights the efficacy of orthognathic surgery in addressing oropharyngeal and aesthetic deficits. This study identifies relapse and velopharyngeal insufficiency as recurrent complications. These insights inform surgical refinement and patient counseling, laying a foundation for enhanced clinical protocols.