Improved Outcomes in Cleft Patients with Severe Maxillary Deficiency after Le Fort I Internal Distraction

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Abstract

Background:

Correction of severe maxillary deficiency in cleft lip–cleft palate patients often results in undercorrection, relapse, and need for secondary corrective procedures. Le Fort I internal distraction osteogenesis offers an alternative to one-step orthognathic advancement, with advantages of gradual lengthening through scar and earlier treatment in growing patients.

Methods:

Patients with cleft lip–cleft palate deformities and maxillary deficiency were divided into three groups treated by Le Fort I advancement: group 1, mild to moderate deficiency (<10 mm) with conventional orthognathic procedure; group 2, severe deficiency (≥10 mm) with conventional orthognathic procedure; and group 3, distraction procedure for severe deficiency (≥10 mm) (n = 51). Preoperative, postoperative, and follow-up (>1 year) lateral cephalogram measurements were compared including angular (SNA and SNB) and linear (Δx = horizontal and Δy = vertical) changes. The Pittsburgh Speech Score was used to assess for velopharyngeal insufficiency (score >3).

Results:

Results demonstrated that group 1 patients had a mean SNA change from preoperatively (78.7) to postoperatively (83.8), and a horizontal change of 5.0 mm, with no relapse. Group 2 patients had a mean SNA change from preoperatively (76.3) to postoperatively (82.0) and a horizontal change of 7.2 mm, with 63 percent relapse. Group 3 patients had a mean SNA change from preoperatively (74.1) to postoperatively (84.9) and a horizontal change of 16.5 mm, with 15 percent relapse. Thus, for severe maxillary deficiency, the distraction group had 48 percent less relapse than the conventional Le Fort I group. Postoperative speech evaluation showed velopharyngeal insufficiency in the following: group 1, four of 20 patients (20 percent); group 2, nine of 11 patients (82 percent); and group 3, nine of 20 patients (45 percent).

Conclusion:

These data suggest that Le Fort I internal distraction for severe cleft maxillary deficiency leads to better dental occlusion, less relapse, and better speech results.

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