Stability after rigid fixation of simultaneous maxillary impaction and mandibular advancement osteotomies

Abstract

The purpose of this study was to investigate the short- and long-term stability of bimaxillary surgery following LeFort I (LF-1) impaction with simultaneous bilateral sagittal split ramus osteotomy (BSSO) and mandibular advancement using the technique of rigid internal fixation (RIF). In order to assess the postoperative maxillary and mandibular movement pattern in 26 patients with vertical maxillary excess and mandibular deficiency, cephalograms were taken immediately preoperatively, and 1 week, 2 months, and 1 year after surgery. With paired t-test showing no statistically significant postoperative change for the point A of the maxilla from immediate postsurgery to longest follow-up (P> 0.05), the used technique of ‘RIF LF-I impaction and RIF BSSO advancement’ tended to render excellent postsurgical stability in the horizontal (0.1±0.8mm mean posterior movement) and vertical (0.1±0.5mm mean inferior movement) direction. There was no instance of maxillary relapse of >2mm. Regarding mandibular BSSO advancement, the point B showed a significant vertical upward movement (1.6±1.2mm) (P< 0.001) and a slight horizontal forward movement (0.3±2.0mm) (P> 0.05) at 1-year follow-up. The incidence of posterior relapse of >2mm accounted for 11.5%. The data confirm the concept that the bimaxillary approach of ‘LF-I impaction and BSSO advancement’ using the described technique of RIF is a stable procedure in the treatment of open bite patients classified as vertical maxillary excess in combination with mandibular deficiency.