Five-Year Experience Comparing Resorbable to Titanium Miniplate Osteosynthesis in Cleft Lip and Palate Orthognathic Surgery

Abstract

To evaluate 5-year outcome stability and complications in orthognathic surgery using resorbable versus titanium osteofixation. Twenty-two cleft lip and palate maxillary retrognathia cases were operated on using either poly (70L-lactide-co-30DL-lactide) or titanium miniplate osteofixation. All had two-piece Le Fort I maxillary advancement osteotomy, 11 had simultaneous mandibular setback, and 13 had alveolar bone grafts. Average operative movement and postoperative instability recorded for maxillary horizontal movement (A-point-Nasion) were 2.5 mm and 2.1 mm for the study group, compared with 6.3 mm and 1.9 mm for the control group. For maxillary vertical movement (ANS-Nasion), measured values were 4.9 and 1.3 mm for the study group and 2.3 and 0.9 mm for the controls. For mandibular horizontal movement, measured values were 10.7 mm and 2.8 mm for the study group and 1.9 mm and 0.8 mm for the controls. Gonial angle measures were 7.1 degrees and 3.5 degrees for the study group and 6.7 degrees and 3.1 degrees for the controls. Foreign body granuloma and fistulation occurred in 1 (9%) member of the study group, but was treated successfully with debridement; implant palpability subsided after 24 months. Three (27%) controls required plate removal, but the remaining plates were palpable. In the study group, horizontal maxillary stability appeared inferior to vertical stability, but mandibular stability was more reliable. Because groups were not matched for magnitude or direction of movement, the results of this study are preliminary and should be interpreted cautiously.