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Use of allogenic (iliac) corticocancellous graft for Le Fort I interpositional defects: technique and results
1Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Departments of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC.
Purpose:
We performed a retrospective review of a consecutive series of 50 patients who had undergone Le Fort I with interpositional grafting during a 3-year period.
Materials And Methods:
Maxillary repositioning included horizontal advancement and vertical and transverse change to the extent that an interpositional graft was considered necessary. Allogenic (iliac) corticocancellous bone was used in all cases. Each patient underwent analytic model planning to document the maxillary vector change data points. The recorded data served as an indicator of the osteotomy site gaps requiring grafting. Standardized photographs in centric relation at a minimum of 12 months after treatment were analyzed to measure overjet, overbite, midline position, and first molar lateral occlusion. Specific maxillary region wound healing parameters were reviewed.
Results:
The patients' mean age at surgery was 32 years (range 15 to 60). Analytic model planning clarified that the study patients had an average of 8 mm horizontal advancement, 2 mm vertical lengthening, and 2 mm of transverse expansion. The data confirmed a favorable occlusion at a minimum of 1 year after surgery with maintenance of a normal overjet (49 of 50 patients, 98%), normal overbite (48 of 50 patients, 96%), planned dental midline positioning (45 of 50 patients, 90%), and ideal first molar lateral occlusion (48 of 50 patients, 96%) for most patients. None of the study patients sustained wound healing complications. Also, no cases of postoperative sepsis or viral illness developed.
Conclusions:
The results of the present study have confirmed that iliac corticocancellous allograft has minimal systemic or recipient site complications and can be safely used to fill complex 3-dimensional interpositional defects associated with Le Fort I osteotomy and/or repositioning.
