The 3-dimensional stability of maxillary osteotomies in cleft palate patients with residual alveolar clefts

Abstract

Objectives—To evaluate the stability of maxillary osteotomies in cleft palate patients using miniplate fixation. Design—A prospective clinical study. Subjects—46 consecutive cleft palate patients with residual alveolar clefts and maxillary hypoplasia in one or more dimensions. These patients underwent standardised maxillary osteotomies and simultaneous bone grafting of the alveolar cleft over 44 months during 1988–1992. Titanium mini-plate fixation was used for the maxilla in all patients. Follow-up ranged from 6 to 51 months with a mean of 28 months. Main outcome measures—The 3-dimensional stability of maxillary osteotomies in cleft palate patients in the long term. Results—In the unilateral clefts, relapse in the horizontal plane was 22% and in the vertical plane 22.5%; in bilateral clefts, the relapse was 17.5% and 7% respectively, with no statistically significant difference between the two groups. Longitudinal analysis of the repositioned maxilla over a 3-year period showed that most of the relapse occured in the first 6 months and stabilised at 2 years postoperatively. Relapse in the transverse plane, based on analysis of the study models of 26 cases, ranged from 13.4% to 33.6%. A clockwise rotational relapse of the maxilla was noted in bilateral cases. Postoperative orthodontics compensated for the horizontal relapse by increasing incisor proclination to maintain positive overjet. There was no significant difference between the relapse of bimaxillary cases and that of maxillary osteotomies alone. Conclusion—The long-term 3-dimensional surgical stability, using miniplate fixation, has decreased the relapse of cleft maxillary osteotomies with simultaneous alveolar bone grafting to a level comparable to that of maxillary osteotomies in non-cleft patients.