Importance of soft tissue for skeletal stability in maxillary advancement in patients with cleft lip and palate

Cleft Palate Craniofac J. 2003 Jan;40(1):65-70. doi: 10.1597/1545-1569_2003_040_0065_iostfs_2.0.co_2.

Abstract

Objective: Assessment of stability of the advanced maxilla after two-jaw surgery and Le Fort I osteotomy in patients with cleft palate based on soft tissue planning.

Subjects: Between 1995 and 1998, 15 patients with cleft lip and palate deformities underwent advancement of a retruded maxilla, without insertion of additional bone grafts. Eleven patients had bimaxillary osteotomies and four patients only a Le Fort I osteotomy. Relapse of the maxilla in horizontal and vertical dimensions was evaluated by cephalometric analysis after a clinical follow-up of at least 2 years.

Results: In the bimaxillary osteotomies, horizontal advancement was an average 4 mm at point A. After 2 years, there was an additional advancement of point A of an average of 0.7 mm. In the mandible, a relapse of 0.8 mm was seen after an average setback of 3.9 mm. In the four patients with Le Fort I osteotomy, point A was advanced by 3.8 mm and the relapse after 2 years was 0.9 mm. Vertical elongation at point A resulted in relapse in both groups. Impaction of the maxilla led to further impaction as well.

Conclusion: Cephalometric soft tissue analysis demonstrates the need for a two-jaw surgery, not only in severe maxillary hypoplasia. Alteration of soft tissue to functional harmony and three-dimensional correction of the maxillomandibular complex are easier to perform in a two-jaw procedure. It results in a more stable horizontal skeletal position of the maxilla.

MeSH terms

  • Adolescent
  • Adult
  • Cephalometry
  • Chin / pathology
  • Cleft Lip / surgery*
  • Cleft Palate / surgery*
  • Face*
  • Facial Bones / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Malocclusion, Angle Class III / pathology
  • Malocclusion, Angle Class III / surgery
  • Mandible / pathology
  • Mandible / surgery
  • Maxilla / abnormalities
  • Maxilla / pathology
  • Maxilla / surgery*
  • Nose / pathology
  • Osteotomy
  • Osteotomy, Le Fort / classification
  • Patient Care Planning
  • Recurrence
  • Sella Turcica / pathology
  • Statistics, Nonparametric
  • Vertical Dimension