Two-point nasomaxillary fixation of the Le Fort I osteotomy: assessment of stability at one year postoperative

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.

Stability of Le Fort 1 osteotomy in patients with bilateral cleft lip and palate: A retrospective study of 71 patients

The aim of this study was to evaluate the sagittal and vertical relapses after Le Fort 1 osteotomy in bilateral cleft lip and palate (BCLP) patients. Lateral cephalograms before surgery, immediately after the procedure, at one year, and at least two years (when available) after surgery were superimposed. The positions of five landmarks were studied in a coordinate system. Uni- and multivariate analyses investigated the effect of various factors on the relapse. Of the 71 patients included for a BCLP, 54 presented complete data at one year, and 30 patients were included for the long follow-up study (mean of 55 months). The mean maxillary advancement was 6.2 mm on the sub-spinal point (A). Sagittal relapse occurred at one year (mean of 1.1 mm on point A, 0.7 mm on point prosthion (P); p < 0.0001) and progressed by 0.5 mm and 1.0 mm, respectively, on the same points at the last follow-up. The mean vertical relapse was 0.5 mm on point A (p = 0.044), 0.6 mm on point P (p = 0.16) and 0.5 mm on incisor (I) (p = 0.056). The vertical relapse was correlated to the degree of vertical movement. Three factors were associated to the recurrence including a prior pharyngeal flap, an associated mandibular osteotomy and smoking habits.

Postoperative skeletal stability at the one-year follow-up after splintless Le Fort I osteotomy using patient-specific osteosynthesis versus conventional osteosynthesis: a randomized controlled trial

The purpose of this study was to assess the 1-year skeletal stability of the osteotomized maxilla after Le Fort I surgery, comparing conventional osteosynthesis with patient-specific osteosynthesis. Patients were assigned to a conventional or patient-specific osteosynthesis group using prospective randomization. The primary outcome was the three-dimensional change in postoperative skeletal position of the maxilla between the 2-week and 1-year follow-up cone beam computed tomography scans. Fifty-eight patients completed the protocol for the 2-week postoperative analysis, and 27 patients completed the 1-year follow-up study protocol. Of the 27 patients completing the entire protocol, 13 were in the conventional group and 14 in the patient-specific osteosynthesis group. The three-dimensional translation analysis showed that the use of the patient-specific osteosynthesis resulted in a skeletally stable result, comparable to that of conventional miniplate fixation. For both the patient-specific osteosynthesis and conventional miniplate fixation groups, median translations of less than 1 mm and median rotations of less than 1° were observed, indicating that both methods of fixation resulted in a stable result for the 27 patients examined. For the Le Fort I osteotomy, the choice between patient-specific osteosynthesis and conventional osteosynthesis did not affect the postoperative skeletal stability after 1 year of follow-up.

Biomechanical evaluation of two miniplate fixations applied in the anterior region after Le Fort I osteotomy: an experimental study

The aim of this experimental study was to evaluate the reliability of two-plate fixations applied to the anterior region of the maxilla after Le Fort I osteotomy in terms of stability. Twenty polyurethane-based skull models were used to evaluate two fixation techniques. Two groups consisting of four and two L-shaped titanium miniplates were tested. Each group was tested with the application of vertical forces in the anteroposterior direction using a servohydraulic testing unit. The displacement values in each group at each stage (from 10 N - 120 N) were compared using the Mann-Whitney U test. The displacement values for the two groups were not statistically significant up to 20 N, but differed significantly between 20 N and 120 N (p < 0.05). The results showed that the biomechanical behaviour of fixation with four miniplates was better than that of two after a load of 20 N. It can be concluded that when the amount of maxillary advancement is increased to 10 mm or more, fixation with only two plates does not provide sufficient stability experimentally.

Comparison of the postoperative stability after repositioning of the maxilla with Le Fort I osteotomy using four- versus two-plate fixation

INTRODUCTION

Le Fort I osteotomy procedures requires miniplates fixation in both the aperture piriformis and zygomaticomaxillary buttress.

PURPOSE

The purpose of this study was to compare the postoperative stability of the Le Fort I osteotomy using four-plate versus two-plate fixation.

MATERIAL AND METHODS

This study involved 39 Class III patients who underwent one-piece Le Fort I osteotomy with bilateral sagittal split ramus osteotomy. In group I, four miniplates were placed at the apertura piriformis and the zygomaticomaxillary buttress, whereas, in group II, fixation was achieved with two miniplates bilaterally placed at the piriform apertura with no posterior fixation. Linear and angular measurements included maxillary sagittal and vertical positions. The primary outcome of this study was stability, as recorded by lateral cephalometric measurements of the preoperative, immediately postoperative and late postoperative periods.

RESULTS

Significant immediate postsurgical changes were found in both groups. In the late postoperative cephalometric measurements, all skeletal parameters showed significant stability in groups I and II. In terms of vertical and sagittal relapse, there was no significant difference between the four-plate and two-plate groups (p1=0.686 and p2=0.513, respectively).

CONCLUSION

A good postoperative stability can be obtained with a two-plate fixation after one-piece Le Fort I osteotomy.