Long-Term Results after Maxillary Advancement in Patients with Clefts

Abstract

In order to evaluate relapse tendencies after maxillary advancement, 31 patients were examined preoperatively, postoperatively, and 1 year postoperatively; 14 of whom had clefts of the lip, alveolus, and palate. Patients with maxillary deficiency were selected in a method that mere sagittal displacement was planned. Any patients with major vertical or transverse changes or additional mandibular surgery were excluded. Treatment consisted of maxillary advancement by Le Fort I osteotomy and miniplate fixation. Besides clinical examination, skeletal and dental changes were assessed cephalometrically. Results revealed a certain relapse tendency of the displacement in the noncleft group that compared favorably to the cleft group. This relapse is dependent on the amount of advancement. Despite minor differences, the two groups did not differ significantly based on maxillary advancement, so besides advancement surgery there must be another factor, cleft, to explain the different relapse tendencies between patients with and without clefts.

Impact of the Distance of Maxillary Advancement on Horizontal Relapse After Orthognathic Surgery

“…Bhatia et al showed that maxillary stability after surgery did not depend on the amount of advancement even when the anteroposterior movement was 10 to 22 mm (Bhatia et al, 2016). Others have found a positive association, suggesting larger maxillary advancement results in a greater likelihood of relapse; however, this relation appeared to have minimal to no clinical significance (Houston et al, 1989; Hochban et al, 1993; Kiely et al, 2006). Of these studies, Kiely et al showed that a positive relation existed between the magnitude of the surgical movement and the magnitude of postoperative relapse after 1 year; however, the average horizontal mean relapse was 0.249 mm, which was considered clinically insignificant (Kiely et al, 2006).…”

“…It is generally agreed that CL/P is associated with a higher risk of relapse; however, other factors are not well established (Hochban et al, 1993; Bhatia et al, 2016). We have found that patients with CL/P had an average of 1.248 mm greater horizontal relapse than patients without CL/P, even though in our sample, the preoperative reverse overjet and the degree of maxillary advancement were similar in both cleft and noncleft groups.…”

The role of computer‐aided 3D surgery and stereolithographic modelling for vector orientation in premaxillary and trans‐sinusoidal maxillary distraction osteogenesis

“…Treatment of CLP or trauma patients with severe maxillary hypoplasia requires a combination of bone grafting, orthognathic surgery or distraction osteogenesis (9,11,14,16,17). Acute skeletal advancements of the mid-face often results in postoperative relapses when the maxilla is advanced more than 10 mm or the procedure is performed at puberty (18).…”

“…Acute skeletal advancements of the mid-face often results in postoperative relapses when the maxilla is advanced more than 10 mm or the procedure is performed at puberty (18). Skeletal relapses were reported to occur following Le Fort I advancement within the range 22-40% in the horizontal plane and 19-70% in the vertical plane (16)(17)(18)(19). To overcome such relapses, distraction osteogenesis is indicated, with gradual advancement of a retruded maxilla by intraoral or extraoral devices (9,10,12,14).…”

Postoperative Complications Following LeFort 1 Maxillary Advancement Surgery in Cleft Palate Patients

“…In the most recent systematic review, cleft relapse rates are quoted at 17.9% for mean horizontal relapse and 35.4% for mean vertical relapse (Yamaguchi et al, 2016) . The reason for such differences in relapse includes greater soft tissue tension, scarring, and instability of the bony segments in cleft patients (Hochban et al, 1993) .…”