Le Fort III distraction using rotation advancement of the midface in patients with cleft lip and palate

Patients with cleft lip and palate demonstrate a spectrum of maxillary growth deficiencies. The purpose of this study was to review the authors' experience in the treatment of midface hypoplasia in nonsyndromic cleft lip-cleft palate patients using rotation advancement of the midface with Le Fort III distraction.

A retrospective chart review was conducted to include all patients with nonsyndromic cleft lip and/or cleft palate who underwent Le Fort III rotation advancement of the midface from 1999 to 2011. Along with standard outcome measures, Amira imaging software was used to perform surface analysis on the last five consecutive patients in this series.

Forty-three consecutive patients met inclusion criteria. Diagnoses included unilateral complete cleft lip and palate (n = 25) and bilateral complete cleft lip and palate (n = 18). Average distraction distance measured 10.1 mm at the level of the zygoma (range, 6 to 15 mm). Preoperative and 6-month postoperative sella, nasion, A point angles measured 76.3 and 81.8 degrees; whereas sella, nasion, B point angles measured 79.9 and 78.7 degrees, respectively. Preoperative and 6-month postoperative overjet measured -5.4 and 3.2 mm, whereas overbite measured 1.9 and 1.1 mm, respectively. Six patients (13 percent) developed pseudorelapse, with five patients going on to have subsequent Le Fort I advancement at an average of 7 years after distraction (range, 2 to 11 years).

Le Fort III rotation advancement of the midface addresses severe midface deficiencies in select patients. Whereas older techniques target occlusal correction alone, extending osteotomies to the Le Fort III level allows occlusal correction along with improvements in malar and nasal projection required to achieve facial harmony in this group of patients.

Therapeutic, IV.