Stability of the Le Fort I maxillary osteotomy after rigid internal fixation

Abstract

This article adds to the growing list of reports and the volume of data that collectively support the use of rigid internal fixation over other methods of fixation after Le Fort I maxillary osteotomies. The basis for the support of plate and screw fixation is improved postsurgical stability. Rotter and Zeitler avoid discussion of other advantages or disadvantages of rigid fixation compared with wires and maxillomandibular fixation. Instead, they add further hard data to the literature to advance the science of our art. To compare their findings with those of previous researchers who used interosseous wires and wire suspension, the current study was designed to follow closely the methods of Bishara et al.’ The study is admittedly not controlled, and it is retrospective in nature, yet it adds to the growing volume of evidence on this subject. Although many previous studies have looked at stability by using populations of patients that included multiple variables of combined osteotomies, segmental osteotomies, and movements of variable degree in variable directions, these authors are to be commended for their selection of a study population limited to superior maxillary movements. The total number of patients included is therefore small (N = 19) and, so as not to decrease this number further, patients were included who had either anterior or posterior movements concomitant to the superior movement, who had segmental maxillary osteotomies, and who had either 2 or 4 plates used for the internal fixation. No numerical breakdown of the numbers of these variables is offered for the reader’s assessment, so further discussion of possible specific influences on the results is not possible. However, general possibilities can be mentioned. First, with the inclusion of both posterior and anterior planned maxillary movements, one may question whether the differing amounts of bony contact expected to occur in these groups leads to a difference in stability. This variable of expected bony contact is even greater when segmental maxillary osteotomies are also included. It is potentially a further indication of the increased stability of plate fixation compared with wire fixation that excellent stability was seen in spite of these variables. Second, it is probably a stretch of the imagination to call small plate lixation “rigid” regardless of the number of plates used. Including both patients treated with 2 and those treated with 4 plates begs the question further. To add significantly to the reader’s understanding and evaluation of the data presented in the article, the number of patients in each category, their individual results, and the authors’ reasons for choosing 1 method over the other should have been included. Of less likely significance was the inclusion of patients with preoperative apertognathia and those undergoing concomitant mandibular symphyseal modifications. In short, Rotter and Zeitler have added to the growing evidence that plate and screw fixation provides advantages with regard to postsurgical stability in superior repositioning of the maxilla. The authors have faced the same limitations as other investigators with regard to sample size, diagnosis and treatment variables, and study methodology. As Proffit has stated previously about the comparison of postoperative stability between plate and screw fixation and wire fixation, “Additional data on these points are needed. Careful examination of outcomes of treatment in patients defined by their pretreatment characteristics . is necessary to provide the information that clinicians need.“*