Long-term effects of Le Fort I osteotomy for resection of juvenile nasopharyngeal angiofibroma on maxillary growth and dental sensation.

Abstract

To analyze the long-term effects of the Le Fort I osteotomy approach for the resection of juvenile nasopharyngeal angiofibroma (JNA) on maxillary growth and dental sensation. Prospective collection of structured data. Tertiary care academic teaching hospital. Between 1993 and 1998, 5 adolescents (aged 10-14 years) constituted the evaluable cohort among 14 patients who underwent Le Fort I osteotomy for JNA resection. Mean follow-up was 47.2 months. The Le Fort I osteotomy approach was used to resect JNA. Cephalometric x-ray films were taken at various postoperative intervals to assess maxillary growth. The results were matched against age-correlated predictions from Dentofacial Planner software. Horizontal and vertical maxillary growth were each measured anteriorly and posteriorly by comparing interval postoperative cephalometric x-ray films. Dental sensation was longitudinally evaluated by performing interval pulp testing postoperatively. (1) Average vertical growth of the maxilla achieved 30% of predicted growth anteriorly (P =.02). (2) Average horizontal growth matched predicted growth in all patients. (3) All patients demonstrated long-term maxillary dental denervation. Le Fort I osteotomy provides excellent surgical exposure for resection of JNA in the growing facial skeleton. Although it significantly affects vertical but not horizontal growth, its cosmetic effect is negligible. It also causes long-term dental denervation, which in most cases is undetected by patients.