The aim was to systematically review the maxillary incisor exposure and upper lip position changes with Le Fort I type osteotomies for advancement ± impaction with rigid internal fixation, taking into account the use of cinch sutures and VY closures. Electronic databases (Cochrane Library, Medline, Embase, and Web of Science) were searched using medical subject headings (MeSH), key words, truncations, and Boolean operators. Hand searching was also undertaken. Of 979 articles identified, 15 were included (11 retrospective, two prospective, and two unspecified). Relevant study details and outcomes were recorded on a spreadsheet, along with an assessment of their quality. In total, these studies assessed 419 patients (266 female, 118 male) with a mean age of 26.4 years (range 14-57 years). Soft tissue changes were assessed on lateral cephalometric radiographs. The mean maxillary hard tissue advancement and impaction ranged between 0.94 and 8.77 mm and -0.56 and 4.2 mm, respectively. The ranges of ratios demonstrated that from pronasale (0.24-0.35) to labrale superius (0.36-1.43), the soft tissues followed the underlying horizontal hard tissue movement increasingly more closely. Alar base cinch sutures and VY closures tended to increase these ratios. The soft tissue response was more variable vertically. None of the studies reported on maxillary incisor exposure change. More good quality prospective studies are needed.
Keywords: Le Fort I osteotomy; VY closure; cinch suture; maxillary incisor exposure; orthognathic surgery.
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