Improved outcomes in cleft patients with severe maxillary deficiency after Le Fort I internal distraction

Anand Kumar, Joubin S. Gabbay, Rabin Nikjoo, Justin B. Heller, Catherine M. O'Hara, Manisha Sisodia, J. I. Garri, Libby S. Wilson, Henry K. Kawamoto, James P. Bradley

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1499-1509
Number of pages11
JournalPlastic and reconstructive surgery
Volume117
Issue number5
DOIs
StatePublished - Apr 15 2006
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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