Maxillary Le Fort Research Articles

Anatomic and functional masseter muscle adaptation following orthognathic surgery—MRI analysis in 3 years of follow-up

BackgroundOrthodontic and surgical technical advances in recent years have resulted in treatment opportunities for a whole range of craniofacial skeletal disorders either in the adolescent or adult patient. In the growing child, these can include myofunctional orthodontic appliance therapy or distraction osteogenesis procedures, while in the adult, the mainstay approach revolves around orthognathic surgery.The literature agrees that for a change in craniofacial morphology to remain stable, the muscles acting upon the facial skeleton must be capable of adaptation in their structure and, therefore, their function. Failure of the muscles to adapt to the change in their length or orientation will place undesirable forces on the muscle attachments leading to potential instability of the skeleton. Adaptation can occur through various processes including those within the neuromuscular feedback mechanism, through changes within muscle structure or through altered muscle physiology, and through changes at the muscle/bone interface.It is now accepted that because there is no single method of assessing masticatory function, several measures should be taken, and whenever possible, simultaneously.MethodsThis investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure and function to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Patients attending the combined orthodontic/orthognathic surgery clinic at the Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa, Portugal, were screened. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were selected to form the study group.The patients have MRI of the masseter muscle to evaluate the masseter muscle volume and fibre orientation changes. This exam was taken before surgery (T0), 6 to 12 months after surgery (T1), and 3 years after surgery (T2), by two independent observers, according to the protocol jointly developed between the Eastman Dental Institute – University of London and the MRI Centre - Department of Radiology at John Radcliffe Hospital – University of Oxford.ResultsSignificant differences (p < 0.05) have been identified between Time 0 (pre-op) and Time 1 (6–12 months post-op) regarding the masseter area (mm2). The differences against Time 0 (pre-op) seem to disappear at Time 2 (3 years post-op).ConclusionsMRI therefore seems to be a valid tool for measuring differences in the masseter muscle area and volume associated with high-severity occlusal deformities, although showing not to be as efficient in detecting the same differences in cases of low-severity occlusal deformities.

Evaluation of occlusal force changes in orthognathic surgery using force-sensing sensors in 3 years of follow-up.

The aim of this study was to test a prototype device called occlusal force diagnostic system in relation to occlusal force adaptation following orthognathic surgery. Retrospective study of 10 patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible; in a 3 years follow-up period. The selection of examiner is not a variable that affects the occlusal force (N) measured by FSS sensors in any of the experimental conditions tested. The sensor position and the surgery recovery time affect the occlusal force irrespective of the examiner selection and/or the surgery recovery time. The piezoelectric sensors used in the present study have shown high reliability and validity of measurement. The surgery recovery time impacts the occlusal force (N), with a 50% increase in occlusal force (N) measured after 6 months post-surgery, with the value keeping stable at 36 months. This suggests that the patient is only fully recovered from the functional point-of-view at 6 months, having from that point on an improved and stable masticatory function.

MSCT 3D Analysis of Nasopharyngeal Airway After Le Fort I Maxillary Setback Surgeries.

In recent years, maxillary Le Fort I osteotomy setback has been widely applied in correcting maxilla prognathism. In the meantime, airway considerations have attracted more and more attention. The aim of this research was to observe the alteration of nasopharyngeal airway indexes after maxilla setback and offer evidence for the effectiveness and safety of maxillary Le Fort I setback surgeries. As for a retrospective cross-sectional study, 40 patients diagnosed with maxilla prognathism and undergoing maxillary setback surgeries were enrolled. They were grouped by the type of maxillary setback operations as group A (integral maxillary setback, n=19) and group B (segmental maxillary setback, n=21). Multislice computed tomography data were collected 1 week before (T0) and more than 3 months (T1) after surgery. 3D reconstruction and evaluation of the pharyngeal airway were conducted to analyze nasopharyngeal airway index variation before and after surgery and the difference between group A and group B. Preoperative and postoperative nasopharyngeal airway volume showed no statistical significance in group A (P=0.872) and group B (P=0.169) as well as other indexes of the nasopharynx. The comparison of postoperative airway changes between group A and group B also showed no significant difference. Both integral and segmental maxillary Le Fort I osteotomy setbacks have slight impact on nasopharyngeal airway dimensions and are safe within a specific setback range.

Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach.

Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. Eighteen patients 14-25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14-18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.

Effects of distraction osteogenesis with Le Fort osteotomies on upper airway volumes: a systematic review and meta-analyses

ObjectiveDistraction osteogenesis is one of the treatment options in patients with severe maxillomandibular abnormalities to treat morphological and respiratory problems (obstructive sleep apnea syndrome). The study aimed to evaluate the effect of Le Fort I, II and III distraction osteogenesis (DO) on upper airway dimensions and respiratory function. MethodsElectronic search was performed in PubMed, Scopus, Embase, Google Scholar and Cochrane databases. Studies that only involved two dimensional analyses were excluded. Besides, studies that performed DO in conjunction with orthognathic surgery were not considered. NIH quality assessment tool was used to evaluate the risk of bias. Meta-analyses were performed to assess sleep apnea indices and the mean differences in the airway dimensions before and after DO. Gradings of Recommendations, Assessment, Development and Evaluation were used to analyze the evidence level. ResultsAmong the 114 studies that went under full-text analyses, 11 articles met the inclusion criteria. Results of the quantitative analyses showed that maxillary Le Fort III DO significantly increased the amounts of oropharyngeal, pharyngeal and upper airway volumes. However, apnea-hypopnea index (AHI) showed a non-significant improvement after this procedure. Besides, the dimensions of the airways increased with Le Fort I and II DO, according to a qualitative analysis. Considering the design of the included studies, our results had a low level of evidence. ConclusionMaxillary Le Fort DO does not significantly impact AHI, while it significantly increases the airway dimensions. Meanwhile, multicentric studies with standardized evaluation are still required to confirm the effects of maxillary Le Fort DO on airway obstruction.

Accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery

ObjectiveTo determine the accuracy of maxillary positioning using computer-designed and manufactured occlusal splints or patient-specific implants in orthognathic surgery.Material and MethodsA retrospective analysis of 28 patients that underwent virtually planned orthognathic surgery with maxillary Le Fort I osteotomy either using VSP-generated splints (n = 13) or patient-specific implants (PSI) (n = 15) was conducted. The accuracy and surgical outcome of both techniques were compared by superimposing preoperative surgical planning with postoperative CT scans and measurement of translational and rotational deviation for each patient.ResultsThe 3D global geometric deviation between the planned position and the postoperative outcome was 0.60 mm (95%-CI 0.46–0.74, range 0.32–1.11 mm) for patients with PSI and 0.86 mm (95%-CI 0.44–1.28, range 0.09–2.60 mm) for patients with surgical splints.Postoperative differences for absolute and signed single linear deviations between planned and postoperative position were a little higher regarding the x-axis and pitch but lower regarding the y- and z-axis as well as yaw and roll for PSI compared to surgical splints.There were no significant differences regarding global geometric deviation, absolute and signed linear deviations in the x-, y-, and z-axis, and rotations (yaw, pitch, and roll) between both groups.ConclusionsRegarding accuracy for positioning of maxillary segments after Le Fort I osteotomy in orthognathic surgery patient-specific implants and surgical splints provide equivalent high accuracy.Clinical relevancePatient-specific implants for maxillary positioning and fixation facilitate the concept of splintless orthognathic surgery and can be reliably used in clinical routines.

Surgical-Orthodontic Treatment of Class III Malocclusion with Anterior Open Bite

A 21-year-old female came with chief complaints of inability to incise food and poor esthetics. The patient presented with a concave facial profile, long face with a steep mandibular angle, incompetent lip closure, and acute nasolabial angle. Intraorally, she had negative 6 mm overjet, 3 mm open bite and dental crowding. She was diagnosed as severe skeletal Class III malocclusion and anterior open bite. The treatment plan included orthodontic treatment with orthognathic surgery and extraction of maxillary second molars, which were supra-erupted and tipped buccally. The pre-operative orthodontic alignment took 11 months. The surgical correction included maxillary Le Fort I osteotomy with 4 mm advancement, mandibular intraoral vertical ramus osteotomy with 6.5 mm setback and genioplasty. The total surgical-orthodontic treatment time was 16 months. The final result presented a straight profile with stable occlusion. The patient’s facial and dental esthetics, masticatory function, and quality of life were all significantly improved after surgical-orthodontic treatment.

Transmucosal pterygomaxillary disjunction using a piezoelectric device, in the context of the minimally invasive Le Fort I osteotomy protocol

The aim of this study was to assess the accuracy and clinical implications of pterygomaxillary junction (PMJ) disjunction with a transmucosal PMJ osteotomy using a piezoelectric hand-piece device, in the context of Le Fort I osteotomy, by evaluating the level of PMJ disarticulation and the need for bone trimming around the pedicle. An ambidirectional 1-month follow-up cohort study was designed involving consecutive patients undergoing minimally invasive maxillary Le Fort I osteotomy through the twist technique. Two cohorts were defined according to whether or not the transmucosal PMJ osteotomy was performed. The site of PMJ disjunction was analysed radiographically. A total of 114 patients were included in the study, 57 in each group. The overall accuracy of the PMJ disjunction path was higher in the test group (43.9%) than in the control group (15.8%). Multiple logistic regression analysis identified the need for bone trimming (odds ratio 0.02; P < 0.001) and removal of the upper third molar (odds ratio 0.17; P < 0.001) as relevant factors. In conclusion, compared with the originally described twist technique, combination of the latter with the PMJ osteotomy increased its accuracy at the level of the PMJ. As a result, there is a decrease in resistance during down-fracture and decrease in the need for bone trimming around the pedicle, with preservation of the minimally invasive concept.

Collaborative Control Method and Experimental Research on Robot-Assisted Craniomaxillofacial Osteotomy Based on the Force Feedback and Optical Navigation

Objective:Surgical robot has advantages in high accuracy and stability. But during the robot-assisted bone surgery, the lack of force information from surgical area and incapability of intervention from surgeons become the obstacle. The aim of the study is to introduce a collaborative control method based on the force feedback and optical navigation, which may optimally combine the excellent performance of surgical robot with clinical experiences of surgeons.Materials and Methods:The CMF ROBOT system was integrated with the force feedback system to ensure the collaborative control. Force-velocity control algorithm based on force feedback was designed for this control method. In the preliminary experimental test, under the collaborative control mode based on force feedback and optical navigation, the craniomaxillofacial surgical robot entered the osteotomy line area according to the preoperative surgical plan, namely, right maxillary Le Fort I osteotomy, left maxillary Le Fort I osteotomy, and genioplasty.Results:The force sensor was able to collect and record the resistance data of the cutting process of the robot-assisted craniomaxillofacial osteotomy assisted in real time. The statistical results showed that the repeatability of collaborative control mode was acceptable in bilateral maxillary Le Fort I osteotomies (right, P=0.124>0.05 and left, P=0.183>0.05) and unfavorable in genioplasty (P=0.048<0.05).Conclusion:The feasibility of robot-assisted craniomaxillofacial osteotomy under the collaborative control method based on the force feedback and optical navigation was proved in some extent. The outcome of this research may improve the flexibility and safety of surgical robot to meet the demand of craniomaxillofacial osteotomy.

Does Liposomal Bupivicaine Injection Decrease Postoperative Opioid Usage following Bimaxillary Surgery?

PurposeAmong patients undergoing bimaxillary surgery, does the use of liposomal bupivacaine injection reduce the use of opioid analgesics and/or length of hospital admission in the postoperative period? MethodsA retrospective cohort analysis was conducted on subjects who received orthognathic surgery from 2017 to 2019 at Parkland Memorial Hospital. Inclusion criteria were a maxillary Le Fort I procedure and simultaneous bilateral sagittal split osteotomy. Exclusion criteria were a syndromic condition, repeat surgery, concomitant genioplasty or temporomandibular joint surgery, or single-jaw surgery. The predictor variable was the administration of a standard dosage of 266mg (20mL) of liposomal bupivacaine distributed equally among all 4 surgical sites. The primary outcome variable was the total milligram morphine equivalent (MME) of opioids administered to the subject in the immediate postoperative period. Secondary predictor variables were postoperative hospital stay length, defined in days, age, and sex, defined as male or female. Statistical analysis was performed with P < .05 used to determine statistical significance. ResultsNineteen patients met the defined inclusion criteria. The age at the time of surgery ranged from 17 to 51, with the average age being 26 years old. The cohort consisted of 8 males and 11 females. Ten subjects received an injection of 266mg of liposomal bupivacaine, divided equally among all 4 surgical sites (2 maxillary and 2 mandibular) at the completion of surgery, and 9 subjects received no liposomal bupivacaine.Postoperatively, subjects received varying combinations of PRN opioids, including: codeine, hydrocodone, oxycodone, fentanyl, and hydromorphone. MME for each of these medications was then calculated. Patients in the group who received a liposomal bupivacaine injection required a mean of 9.3 MME during their postoperative course, while the group who did not receive liposomal bupivacaine required a mean of 25 MME. Statistical analysis revealed a significant difference in MME usage between the 2 groups (P =.0243). The average postoperative hospital admission duration was 1.32 days, with no significant difference between the 2 study groups (P = .884). There was no significant difference between sex or age and postoperative MME usage (P = .566 and P = .381, respectively). DiscussionManagement of postoperative pain is not only vital to patients’ surgical experiences, but is imperative in preserving hospital resources, decreasing hospital stay, and decreasing readmission rates. In total, 20-80% of patients experience moderate to severe pain during their postoperative course. Opioids remain the leading modality to manage postoperative pain, but the recent opioid epidemic has motivated clinicians to pursue other pathways, including liposomal bupivacaine for pain management to mitigate the use of large doses of opioids. The results of the present study suggest that administration of 266mg of liposomal bupivacaine, given equally in all 4 surgical sites following bilateral Le Fort I and sagittal split osteotomies, leads to a statistically significant decrease in postoperative opioid usage. Future prospective studies utilizing liposomal bupivacaine and standard multimodal pain control regimens following orthognathic procedures will further explore the efficacy of liposomal bupivacaine in opioid reduction and management of postsurgical pain.

New Design of Bone Hook for Lefort I Osteotomy

This article discribes a new design by surgical Bone hook that is used for maxillary Le Fort 1 osteotomy. This instrument with high quality ,without damage to surrounding tissues can be used in maxillofacial surgeries.

A breakthrough in Maxillary LeFort II fracture reconstruction: Case series of rhinoplasty using diced cartilage fascia graft simultaneously with ORIF

Maxillary Le Fort II fracture reconstruction plays one of the challenging surgery in the field of maxillofacial trauma. The goal of treatment is reduction, reposition, fixation of fractures and restoration of occlusion. However, it is often not enough to bring back the appearance aesthetically. The challenge that we face today is that patients frequently complain about their nose postoperatively, hence, they believe that the deformity still remains. Secondary rhinoplasty post-trauma is often performed to overcome this deformity. We proposed direct rhinoplasty using diced cartilage fascia graft in Maxillary Le Fort II fracture reconstruction to provides better post-op aesthetic appearance.Reporting three cases of Maxillary Le Fort II fractures. All patients had undergone open reduction and internal fixation combined with rhinoplasty using diced cartilage wrapped with fascia.The graft provides a better nasal contour and shape, also camouflage irregularities. There was no clinical signs of graft absorption or infection. The patients were satisfied, and none of the patients complaint about their nose after surgery.Rhinoplasty using diced cartilage fascia graft simultaneously with ORIF is a breakthrough in Maxillary Le Fort II reconstruction. It brings off the incorporation of aesthetic surgery concept into reconstruction, annihilating post-op complaint from patients and preventing secondary rhinoplasty due to previous trauma.

Masseter muscle adaptation following orthognathic surgery - Biomodelling analysis - A pilot study

Purpose: This pilot investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure, function and fibre orientation to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Materials and Methods: Patients attending the combined orthodontic / orthognathic surgery clinic at Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal were screened using Magnetic Resonance Imaging protocol. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were select to form the study group. An Experimental design used to provide information in relation to masticatory muscle adaptation following orthognathic surgery. The study involved the contribution of two independent examiners that measured the changes in fibre orientation at the different jaw positions using AnatomicsTM software, at three different time moments. A combination of different parametric tests has been used to compare the different experimental variables. Results: Statistical differences have been identified between examiners measurements and between operations. There were no significant differences testing different times. Conclusions: The discrepancies between examiners probably arise from small variations in the experimental methodology used by them. The differences between operations reveal masseter muscle adaptation following orthognathic surgery. The measurement of “P1 masseter muscle/ zygomatic bone / process mastoid anterior angle” and “P2 masseter muscle / mandibular angle” can therefore be a valuable tool for controlling the reworking of masseter muscle upon orthognathic surgery.

Maxillary sinus haziness and facial swelling following suction drainage in the maxilla after orthognathic surgery

BackgroundWe investigated the efficacy of a maxillary Jackson-Pratt (J-P) suction drain for preventing maxillary sinus hematoma and facial swelling after maxillary Le Fort I osteotomy (LF1).MethodsWe retrospectively evaluated 66 patients who underwent LF1 at a single institution. Of these, 41 had a J-P suction tube inserted in the mandible and maxilla (maxillary insertion), and 25 had a J-P drain inserted in the mandible only (no maxillary insertion). Facial CT was obtained before and 4 days after surgery. We compared mean midfacial swelling and maxillary sinus haziness by t test and examined correlations between bleeding amount and body mass index (BMI).ResultsFor the maxillary-insertion group, the ratio of total maxillary sinus volume to haziness (57.5 ± 24.2%) was significantly lower than in the group without maxillary drain insertion (65.5% ± 20.3; P = .043). This latter group, however, did not have a significantly greater midfacial soft tissue volume (7575 mm3) than the maxillary-insertion group (7250 mm3; P = .728). BMI did not correlate significantly with bleeding amount or facial swelling.ConclusionsSuction drainage in the maxilla reduced maxillary sinus haziness after orthognathic surgery but did not significantly reduce midfacial swelling.

Surgical Management of Skeletal Class II Deformity Patients- a Case Series

Class II malocclusions constitute a high percentage of ortho-surgically treated cases. Approximately 70% of the patients have associated skeletal discrepancy characterized by an exaggerated sagittal distance between the maxilla and the mandible, which could result in maxillary prognathism, mandibular retrognathism, or both (2) Class II malocclusion can be treated by a combination of maxillary and mandibular surgeries, maxillary surgery alone or by mandible surgery solely depending on the underlying skeletal discrepancy i.e Maxillary Le Fort I superior repositioning with autorotation of mandible, Bi-jaw surgery—bilateral sagittal split osteotomy (BSSO) along with maxillary Le Fort I impaction., Genioplasty-advancement of chin. Material and methods: 10 cases of Skeletal Class –II malocclusion were selected randomly irrespective of age, sex, caste, religion, etiology and socioeconomic status, good general health without any systemic disease. Study was conducted in the Department of Oral and Maxillofacial Surgery, Karnavati School of Dentistry, Uvarsad. Conclusion: 14 According to the outcomes of the cases it provided a reliable esthetic and functional enhancement of the patient when maxilla was superiorly positioned, with mandibular advancement, genioplasty for retruded chin according to the treatment planned for each patient.

Maxillary distraction osteogenesis and a Le Fort I osteotomy for severe maxillary retrognathia in cleft lip and palate: a case report

Abstract Background The correction of severe maxillary retrognathia in patients presenting with a cleft palate is challenging due to the complexity of the orthodontic preparation and the magnitude of the surgical movements required, along with the relatively high risk of relapse. Materials and methods An 18-year-old Caucasian male with a repaired left-side unilateral cleft lip and palate presented with concerns relating to poor facial aesthetics and poor occlusion. Multidisciplinary treatment involving orthodontics and orthognathic surgery were undertaken to correct the severe maxillary retrognathia. The correction involved the use of internal distraction osteogenesis followed by a conventional maxillary Le Fort I advancement with rotation. Results Pre- and post-treatment lateral cephalogram measurements showed the maxilla was advanced 18 mm, rotated clockwise producing a 9 mm increase in vertical dimension at A point and a 7 mm gain in relative arch width across the first molars. Follow-up CBCT superimpositions showed excellent skeletal stability of the achieved anterior-posterior, lateral and vertical corrections over a 2.4-year period, although there was some minor dental relapse. Conclusion This case report illustrates the successful use of orthodontics and distraction osteogenesis followed by conventional Le Fort I advancement surgery to correct a severely retrognathic maxilla in a patient with a repaired unilateral cleft lip and palate.

Accuracy of patient-specific implants and additive-manufactured surgical splints in orthognathic surgery — A three-dimensional retrospective study

IntroductionBecause of the many limitations of conventional surgery planning for the treatment of orthognathic deformities, as well as advancements in computer-assisted planning, there is an urgent need for technical devices that transfer the surgical plan into the operating theatre. In this regard, additive-manufactured, patient-specific implants (PSI) and additive-manufactured interocclusal splints represent promising approaches. The aim of this retrospective study was to compare the accuracy of these two devices, with regard to preoperative virtual treatment planning for maxillary Le-Fort I advancement surgery using IPS CaseDesigner®, and based on a new analysis method without the use of landmarks. Materials and methodsA retrospective evaluation of 18 class III patients (n(PSI) = 9; n(splint) = 9), who had undergone virtually planned orthognathic surgery (including maxillary Le Fort I advancement), was performed. The preoperative treatment plan and the postoperative outcome were combined to calculate the translational and rotational discrepancies between the 3D planning and the actual surgical outcome. ResultsFor the PSI and splint groups the accuracy of left/right positioning was 0.51 mm ± 0.48 and 1.11 mm ± 1.32 respectively. The accuracy of anterior/posterior positioning was 0.39 mm ± 0.26 and 1.42 mm ± 0.87, and that of up/down-positioning was 0.44 mm ± 0.31 and 0.62 mm ± 0.47. The rotational discrepancies were less than 2° in both groups. Conclusion: The findings demonstrate that both PSI and splint approaches can accurately transfer the virtual planning into the operating theatre. However, PSIs show an overall higher accuracy, especially for anterior/posterior translational movement (p < 0.002).

Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy.

The Le Fort I maxillary osteotomy is a versatile and simple procedure, which has gained popularity nowadays, to correct a wide range of malocclusion and maxillofacial deformities. This procedure is often associated with significant but rare postoperative complications. The aim of this study was to evaluate the types and frequencies of intra- and perioperative complications related to Le Fort I osteotomies in noncleft Iranian patients. In this prospective study, all the healthy systemic patients, (ASA I, II) with the age range of 18 to 30 years from both genders, who had the skeletal class II or III deformities and required only isolated 1-piece maxillary Le Fort I osteotomy, were included in this study. These patients had no craniofacial cleft history and were candidates for orthognathic surgery in Maxillofacial Surgery Department of Qaem Hospital of Mashhad (Iran), 2015 to 2017. All of the operations were carried out or supervised by a single surgeon and anesthesiologist using the same protocol. The patients were monitored for occurrence of intra- or postoperative complications till 6 months. The t-test, Chi-squared test, and Fisher exact test were performed for data analysis using SPSS version 16 (SPSS Inc, Chicago, IL). In the present study, a total of 114 consecutive patients with the average age of 22 ± 5 years from October 2015 to November 2017 were recruited. About 77 (67.54%) patients were presented skeletal class III deformity and 37 (32.46%) were class II. The most prevalent maxillary movement after Le Fort I osteotomy was identified to be isolated maxillary advancement in 51 (44.75%) patients. Only 10 (8.77%) of all 114 patients confronted surgical complications. Hemorrhagic complication (arterial bleeding from descending palatine artery and epistaxis) and anatomic complications (septal deviation and bad fracture) would be the most prevalent complications with the frequency of 5.25% and 3.5% in total. Maxillary setback with impaction presented the highest rate (36.4%) of complications compared to other maxillary movement types. On balance, there was a significant association between Le Fort I surgery complications and maxillary movement types in our research (P = 0.002). The rate of intra- and postoperative complications following Le Fort I osteotomy for healthy noncleft adults in our center was low. Therefore, it can be concluded that this technique is safe and reliable. The maxillofacial surgeon should pay more attention for prevention or even management of the risk of intra- and perioperative complications in patients with anatomic irregularities (previous craniofacial cleft or trauma history) and those who required maxillary setback concomitant with impaction movements.

Horizontal Maxillary Osteotomy Stability Using Mandibular Outer Cortex Bone Grafts in Patients With Cleft Lip and Palate.

To investigate horizontal maxillary osteotomy stability after using bone grafts for the treatment of patients with unilateral cleft lip and palate (UCLP). Retrospective cohort study. Plastic surgery hospital. Fifty-eight patients with UCLP and maxillary hypoplasia requiring a maxillary Le Fort I advancement of 6 to 9 mm. The test group (TG) was comprised of 28 patients who underwent mandibular outer cortex bone grafting in the gaps created by a modified Le Fort I osteotomy. The control group (CG) was comprised of 30 patients who underwent a Le Fort I osteotomy without bone grafts. Maxillary horizontal advancement (recorded during the operation using a Vernier caliper) and horizontal relapse at 12 months after surgery (based on a manual cephalometric analysis of pre- and postoperative lateral teleradiographs). In the TG, the mean maxillary horizontal advancement was 7.13 ± 0.7 mm (range: 6.01-8.23 mm), and the mean postoperative horizontal relapse was 25.07 ± 6.64%. In the CG, the mean maxillary horizontal advancement was 6.90 ± 0.55 mm (range: 6.05-7.39 mm), and the mean postoperative horizontal relapse was 24.89 ± 4.25%. There were no significant between-group differences in the mean horizontal relapses. The use of mandibular outer cortex bone grafts as physical barriers in patients with UCLP does not increase postoperative stability when the maxillary advancement is 6 to 9 mm.

A 3-Dimensional Analysis of Nasal Cavity Volume After Maxillary Le Fort I Osteotomy

Two- and 3-dimensional studies on changes of the pharyngeal airway after a Le Fort I osteotomy have been conducted, but there are few studies on the change of nasal structure. The nasal cavity is the first passage through which air enters during respiration. Movement of the maxilla by Le Fort I osteotomy affects the shape of the nasal cavity and the shape of other parts of the airway. This study compared preoperative and postoperative changes of the nasal cavity volume after a maxillary Le Fort I osteotomy. Pre- and postoperative computed tomograms of 32 patients were assessed for nasal cavity volume according to the direction of maxillary movement. Thirty-two patients (22 men and 10 women) were classified according to the direction of maxillary movement: maxillary impaction (group I; 8 men and 6 women) and maxillary impaction and advancement (group II; 14 men and 4 women). Nasal cavity volume was markedly decreased after the Le Fort I osteotomy in groups I and II. Group I showed a positive correlation between the ratio of impaction and the ratio of volume difference. Group II showed no correlation between the ratio of impaction or advancement and the ratio of volume difference. Impaction and advancement of the maxilla decreased nasal volume.