title: Le Fort III distraction osteogenesis versus conventional Le Fort III osteotomy in correction of syndromic midfacial hypoplasia: a systematic review.
abstract: OBJECTIVE
  It has been debated whether the Le Fort III procedure using distraction osteogenesis (LFIII-DO) reduces the risk of postintervention relapse compared with conventional Le Fort III (LFIII) osteotomy in the correction of syndromic midfacial hypoplasia. Our objective was to evaluate the short- and long-term stability of the bony structures after midfacial advancement using conventional LFIII osteotomy versus LFIII-DO in patients with syndromic midfacial hypoplasia.
  
  
  METHODS
  We performed a systematic review of the published data. An electronic search of 10 databases was performed from their inception through June 2012. The reference lists of the relevant publications were also reviewed. Studies were considered for inclusion if they were longitudinal clinical studies with follow-up periods of at least 1 year after surgery (LFIII group) or at the end of the consolidation period (LFIII-DO group). Study selection, risk of bias assessment, and data extraction were performed in duplicate. The methodologic and clinical heterogeneity across the studies precluded combining the findings using meta-analyses.
  
  
  RESULTS
  A total of 57 reports met the initial search criteria, and 12 reports were finally selected. The studies demonstrated a mean midfacial advancement of 8 to 12 mm in the LFIII group and 9 to 16 mm in the LFIII-DO group. For the LFIII group, horizontal short-term follow-up showed a maximal rate of relapse of 8.7 to 11.9% in 2 studies, with 1 study demonstrating a far more severe rate of maximal relapse of 50%. For the LFIII-DO procedure, the horizontal short-term relapse rate was 14.4% in 1 study, with the remainder demonstrating a rate of relapse of less than 10%. Moreover, 3 studies even showed additional advancement without any rate of relapse.
  
  
  CONCLUSIONS
  Current evidence suggests that conventional LFIII and LFIII-DO techniques can effectively advance the midface forward in patients with syndromic midfacial hypoplasia and have good to excellent stability, with a mild rate of relapse. However, the LFIII-DO technique appears to achieve a greater amount of advancement with a lower rate of relapse compared with the conventional LFIII technique.
authors.affiliation: PhD Candidate and Resident, Orthodontic Graduate Program, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, Edmonton, AB, Canada. Electronic address: saltaji@ualberta.ca.
authors.forename: Humam
authors.initials: H
authors.lastname: Saltaji
authors.affiliation: MSc Resident, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, Edmonton, AB, Canada.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Altalibi
authors.affiliation: Clinical Assistant Professor, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, Edmonton, AB, Canada.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Major
authors.affiliation: Dental Student, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, Edmonton, AB, Canada.
authors.forename: Muhammed H
authors.initials: MH
authors.lastname: Al-Nuaimi
authors.affiliation: Assistant Professor, State University of New York at Buffalo School of Dental Medicine, Buffalo, NY.
authors.forename: Sawsan
authors.initials: S
authors.lastname: Tabbaa
authors.affiliation: Professor and Chair, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, and Senior Associate Dean, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Major
authors.affiliation: Associate Professor and Head, Division of Orthodontics, University of Alberta Faculty of Medicine and Dentistry School of Dentistry, Edmonton, AB, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
mesh_terms: D019465:Craniofacial Abnormalities / Q000601:surgery*; D003394:Craniofacial Dysostosis / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery; D005147:Facial Bones / Q000002:abnormalities* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D019857:Osteogenesis, Distraction / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000145:classification*; D012008:Recurrence; D016896:Treatment Outcome