title: Midfacial volumetric and upper lip soft tissue changes after Le Fort I advancement of the cleft maxilla.
abstract: OBJECTIVE
  To analyze, using 3-dimensional photogrammetric data, midfacial soft tissue and volumetric changes in the cleft maxilla after 1- or 2-piece Le Fort I (LF1) advancement.
  
  
  METHODS
  This was a retrospective study of patients with cleft and maxillary hypoplasia who underwent LF1 advancement. The primary predictor variable was the type of advancement (1 piece vs 2 pieces). Outcome measurements were changes in soft tissue linear measurements (subnasale [Sn], labium superius [LS], and stomion [SO]) and midfacial volume after maxillary advancement.
  
  
  RESULTS
  Eleven patients (7 male, 4 female) underwent LF1 advancements (4 underwent 2-piece advancement). The mean maxillary advancement was 6.2 ± 1.7 mm. Soft tissue changes at the Sn, LS, and SO were 5.2 ± 2.0, 5.8 ± 2.5, and 5.2 ± 1.8 mm, respectively. The average volume change was 12.2 ± 5.7 cm(3). The mean ratios of soft tissue change to the amount of maxillary advancement (millimeters per millimeter) at the Sn, LS, and SO were 0.89 ± 0.49, 0.97 ± 0.44, and 0.89 ± 0.34, respectively. Volume increased by 2.1 ± 1.3 cm(3)/mm. Patients undergoing 1-piece advancement had greater mean advancement and greater soft tissue changes at the LS and SO (P < .03). After controlling for the amount of advancement, 1-piece LF1 osteotomy showed significantly greater improvements at the LS and SO (P < .04).
  
  
  CONCLUSIONS
  Midface advancement at the LF1 level in patients with cleft consistently expands upper lip soft tissue and midfacial volume. Greater changes at the LS and SO were seen with 1-piece than with 2-piece osteotomy.
authors: Plastic Surgery Resident Department of Plastic & Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Srinivas M
authors: SM
authors: Susarla
authors: Plastic Surgery Resident Department of Plastic & Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Jens U
authors: JU
authors: Berli
authors: Associate Professor of Plastic & Reconstructive Surgery Department of Plastic & Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: akumar40@jhu.edu.
authors: Anand
authors: A
authors: Kumar
mesh_terms: D000293:Adolescent; D002508:Cephalometry / Q000379:methods*; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D005145:Face; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007180:Incisor / Q000473:pathology; D008046:Lip / Q000473:pathology*; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D009295:Nasal Bone / Q000473:pathology; D009666:Nose / Q000473:pathology; D019340:Osteotomy, Le Fort / Q000379:methods*; D010780:Photogrammetry / Q000379:methods; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology; D016896:Treatment Outcome