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Technical Modifications Specific to the Cleft Le Fort I Osteotomy.

Srinivas M Susarla1, Russell Ettinger, Kathryn Preston

  • 1Craniofacial Center, Seattle Children's Hospital, Divisions of Plastic and Craniofacial Surgery, Oral and Maxillofacial Surgery, and Craniofacial Orthodontics, Seattle, WA.

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|April 14, 2020
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Summary

A modified Le Fort I osteotomy technique for cleft palate patients significantly improves maxillary advancement and stability. This approach, involving extensive posterior scar release, allows for up to 10mm advancement with less than 1mm relapse at one year.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Craniofacial Surgery
  • Orthognathic Surgery

Background:

  • Cleft palate patients often present with midface hypoplasia requiring orthognathic surgery.
  • Le Fort I osteotomy is a common procedure for maxillary advancement in these patients.
  • Scarring and fibrous tissue in the posterior maxilla can limit mobilization and affect stability.

Purpose of the Study:

  • To describe technical modifications to the cleft Le Fort I osteotomy.
  • To enhance maxillary mobilization during orthognathic surgery.
  • To evaluate the long-term stability of maxillary advancement in cleft palate patients.

Main Methods:

  • Retrospective evaluation of 28 cleft palate patients undergoing Le Fort I osteotomy.
  • Modified technique involved extensive release of posterior maxillary scar tissue.
  • Maxillary position was assessed pre-operatively, immediately post-operatively, and at 1-year follow-up.

Main Results:

  • Mean maxillary advancement was 6.1mm, with a range of 0-10mm.
  • At 1-year post-operatively, mean sagittal relapse was 0.8mm.
  • Advancement magnitude, segmental surgery, bone grafting, or bimaxillary surgery did not significantly impact stability.

Conclusions:

  • A modified cleft Le Fort I osteotomy with extensive posterior release enables significant maxillary advancement.
  • This technique achieves excellent skeletal stability at 1-year post-operatively in cleft palate patients.
  • The described modifications are effective for managing midface hypoplasia in this population.