Intraoral maxillary quadrangular Le Fort II osteotomy: a long-term follow-up study

Abstract

Purpose This study evaluated the clinical outcome and skeletal stability of the intraoral maxillary quadrangular Le Fort II osteotomy (IQLO) with wire or rigid internal fixation following horizontal maxillary advancement. Patients and methods All 21 patients who had undergone the IQLO were analyzed for operation time, blood loss, length of hospitalization, intraoperative and postoperative complications, and radiographic abnormalities. Lateral cephalometric radiographs were taken preoperatively (T1), postoperatively (T2) and late postoperatively (T3) to analyze skeletal movement. Two maxillary landmarks (posterior nasal spine [PNS] and A point) and 2 dental landmarks (the distobuccal cusp tip of the maxillary left second molar [2M] and the maxillary incisal tip [CI]) were used to determine horizontal and vertical changes for each time period. Student t test was used to evaluate early postoperative changes and late postoperative stability. In addition, 21 patients completed a questionnaire at the most recent follow-up visit regarding personal intentions, perceived outcome, and overall satisfaction. Results Twenty-one patients (9 females, 12 males) with an average age of 20.3 years diagnosed with horizontal maxillary-zygomatic deficiency underwent IQLO by 1 surgeon with an average follow-up of 6.3 years. Nine patients received mini-plate osseous segment fixation and 12 patients received wire osseous segment fixation. The mean time from surgery to the first postoperative radiograph (T2) was 4.4 weeks (range 1.0 to 6.7 weeks) and the mean time from surgery to the late postoperative radiograph (T3) was 6.2 years (range, 7.9 to 176.3 months). Statistical analysis of cephalometric landmarks revealed the following significant late postsurgical movements (T3-T2) for wire fixation: PNS moved 1.0 mm inferiorly (SD, 1.2), and 2M moved 1.5 mm inferiorly (SD, 2.2). The remaining cephalometric landmarks for rigid and wire fixation showed no statistically significant late postsurgical movement. Clinical outcome analysis revealed few complications, low surgical and postsurgical morbidity, and excellent patient satisfaction. Conclusion The IQLO is a predictable procedure that exhibits long-term skeletal stability. Long-term retrospective review revealed low postsurgical morbidity and high patient satisfaction.