Improved outcomes in cleft patients with severe maxillary deficiency after Le Fort I internal distraction.
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 (> or = 10 mm) with conventional orthognathic procedure; and group 3, distraction procedure for severe deficiency (> or = 10 mm) (n = 51). Preoperative, postoperative, and follow-up (> 1 year) lateral cephalogram measurements were compared including angular (SNA and SNB) and linear (Deltax = horizontal and Deltay = 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).


CONCLUSIONS
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.
Kumar
Anand
A
Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California, USA.
Gabbay
Joubin S
JS
Nikjoo
Rabin
R
Heller
Justin B
JB
O'Hara
Catherine M
CM
Sisodia
Manisha
M
Garri
J I
JI
Wilson
Libby S
LS
Kawamoto
Henry K
HK
Bradley
James P
JP
D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D019340:Osteotomy, Le Fort; D012189:Retrospective Studies; D013060:Speech; D016896:Treatment Outcome; D014681:Velopharyngeal Insufficiency / Q000209:etiology