Cephalometric Comparison of Le Fort I Osteotomy in Growing and Non-Growing Patients With Clefts: A Retrospective Study.

Abstract

ObjectiveTo cephalometrically compare craniofacial morphology and maxillary advancement in growing versus non-growing patients with clefts undergoing Le Fort I osteotomy.DesignRetrospective cohort study.SettingAll patients underwent maxillary osteotomy at a single tertiary hospital.PatientsThe Pre-Growth-Completion group (PreGC) comprised 28 growing patients (18 males, 10 females; 9 BCLP, 18 UCLP, 1 CP) with a mean age at surgery of 13.5 years (SD = 1.22; range, 11.5-16.7). The Post-Growth-Completion group (PostGC) comprised 59 patients (28 males, 31 females; 15 BCLP, 23 UCLP, 21 CP) with a mean age at surgery of 18.3 years (SD = 4.38; range, 14.5-45.3). Patients with syndromes and those undergoing bimaxillary osteotomies were excluded.InterventionsEach patient underwent Le Fort I osteotomy. Osteotomies were fixed with patient-specific implants or miniplates.Main Outcome MeasuresCephalometric analysis was performed comparing preoperative lateral cephalometric radiographs or CT scans and immediate postoperative lateral cephalometric radiographs.ResultsPatients in PreGC group had more severe preoperative maxillary hypoplasia (SNA 74.2° vs 77.0°, P = .007; ANB -5.2° vs -1.9°, P = .0001), but no significant differences were observed postoperatively (SNA 80.7° vs 78.9°, ANB 2.7° vs 3.9°). Maxillary horizontal advancement was greater in the PreGC group (point A 6.4 mm vs 3.2 mm; P = .00002).ConclusionsPatients undergoing early Le Fort I osteotomy had more severe preoperative maxillary hypoplasia, required greater horizontal advancements, yet achieved significant corrections comparable to patients treated later. However, early osteotomy in growing patients may be considered a 2-stage approach as secondary correction is often required after growth is complete.