Importance of soft tissue for skeletal stability in maxillary advancement in patients with cleft lip and palate.
OBJECTIVE
Assessment of stability of the advanced maxilla after two-jaw surgery and Le Fort I osteotomy in patients with cleft palate based on soft tissue planning.


METHODS
Between 1995 and 1998, 15 patients with cleft lip and palate deformities underwent advancement of a retruded maxilla, without insertion of additional bone grafts. Eleven patients had bimaxillary osteotomies and four patients only a Le Fort I osteotomy. Relapse of the maxilla in horizontal and vertical dimensions was evaluated by cephalometric analysis after a clinical follow-up of at least 2 years.


RESULTS
In the bimaxillary osteotomies, horizontal advancement was an average 4 mm at point A. After 2 years, there was an additional advancement of point A of an average of 0.7 mm. In the mandible, a relapse of 0.8 mm was seen after an average setback of 3.9 mm. In the four patients with Le Fort I osteotomy, point A was advanced by 3.8 mm and the relapse after 2 years was 0.9 mm. Vertical elongation at point A resulted in relapse in both groups. Impaction of the maxilla led to further impaction as well.


CONCLUSIONS
Cephalometric soft tissue analysis demonstrates the need for a two-jaw surgery, not only in severe maxillary hypoplasia. Alteration of soft tissue to functional harmony and three-dimensional correction of the maxillomandibular complex are easier to perform in a two-jaw procedure. It results in a more stable horizontal skeletal position of the maxilla.
Baumann
Arnulf
A
University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical School, University of Vienna, Vienna, Austria.
Sinko
Klaus
K
D000293:Adolescent; D000328:Adult; D002508:Cephalometry; D002680:Chin / Q000473:pathology; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D005145:Face; D005147:Facial Bones / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000473:pathology / Q000601:surgery; D008334:Mandible / Q000473:pathology / Q000601:surgery; D008437:Maxilla / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D009666:Nose / Q000473:pathology; D010027:Osteotomy; D019340:Osteotomy, Le Fort / Q000145:classification; D010347:Patient Care Planning; D012008:Recurrence; D012658:Sella Turcica / Q000473:pathology; D018709:Statistics, Nonparametric; D014716:Vertical Dimension