Clinical Paper
Orthognathic Surgery
Skeletal stability of maxillary advancement with and without a mandibular reduction in the cleft lip and palate patient

https://doi.org/10.1016/j.ijom.2016.08.007Get rights and content

Abstract

The stability of surgical maxillary advancement in a consecutive series of patients with cleft lip and palate who underwent Le Fort I osteotomy with and without simultaneous mandibular setback surgery was evaluated. Preoperative, postoperative, and follow-up lateral cephalograms of 21 patients were assessed to compare differences in surgical movement and postoperative relapse between two groups: those who underwent maxillary surgery alone and those who underwent bimaxillary surgery. Differences in the number of patients who experienced relapse of <2 mm, 2–4 mm, and >4 mm between the groups were also compared. Mean advancement of the cleft maxilla was 5.5 mm in the maxilla only group and 3.6 mm in the bimaxillary group, with a mean horizontal relapse of 0.8 mm and 0.2 mm, respectively. Mean surgical movement in the vertical dimension was comparable in the two groups and the magnitude of vertical relapse was less than 0.4 mm overall. Approximately 80% of patients in both groups experienced horizontal relapse of less than 2 mm. There was no significant difference in the degree of postoperative relapse between those who had single-jaw surgery and those who had two-jaw surgery.

Section snippets

Materials and methods

The oral and maxillofacial surgery unit database was used to identify patients with CLP who had undergone maxillary repositioning during the years 1999–2011. Inclusion criteria were those patients with a diagnosis of a repaired unilateral cleft lip and palate or cleft palate only, treated with a Le Fort I advancement osteotomy. Patients were excluded for any of the following reasons: diagnosis of isolated cleft lip, cleft lip and alveolus only, or bilateral cleft lip and palate; diagnosis of a

Results

An overview of the patient sample is shown in Table 1. An analysis of the preoperative anteroposterior position of the maxilla and relationship of the dental and maxillomandibular structures is shown in Table 2. Mean initial overjet and overbite were the only cephalometric measurements that differed significantly between the two groups (overjet, P = 0.020; overbite, P = 0.004). However, those who had bimaxillary surgery tended to have a more retrusive maxilla and greater maxillomandibular

Discussion

While the preoperative presentation showed considerable individual variation, patients who had bimaxillary surgery generally had a more severe maxillomandibular discrepancy, involving a more retrusive maxilla and a slightly more prognathic mandible, compared to patients who had maxillary surgery alone. This was expected, as the primary problem was maxillary hypoplasia. Often a mandibular reduction was performed simply to correct fully the class III malocclusion, particularly when the maxillary

Funding

None to declare.

Competing interests

None to declare.

Ethical approval

Approved by the Royal Children's Hospital of Melbourne Human Research Ethics Committee (Ref. No. 31218A).

Patient consent

Not required.

Acknowledgements

We thank Dr Constantine Tam for providing guidance with the statistical analysis of the study data and Mita Pederson for assistance with obtaining the cephalograms.

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