LeFort I Horizontal Osteotomy: Defining the Feasibility of the "High Osteotomy"

Area of Science:

• Craniofacial Surgery
• Orthognathic Surgery
• Cleft Lip and Palate Reconstruction

Background:

• Le Fort I osteotomy is a common procedure for correcting midface hypoplasia in patients with cleft lip and palate (CLP).
• The concept of a "high osteotomy" aims to optimize aesthetic and functional outcomes by positioning the osteotomy superiorly.

Purpose of the Study:

• To define the anatomical parameters of a "high osteotomy" in patients with unilateral cleft lip and palate (CLP).
• To assess the feasibility of consistently performing a "high osteotomy" during Le Fort I advancement surgery.

Main Methods:

• Retrospective review of 34 skeletally mature patients with unilateral CLP undergoing Le Fort I osteotomy.
• Analysis of pre- and post-operative cone-beam computed tomography (CBCT) scans to measure key anatomical landmarks.
• Measurements included the superior ala, inferior turbinates, and pyriform aperture to determine osteotomy site relative to these structures.

Main Results:

• The inferior turbinates were located above the superior alar crease in over 73% of cases.
• Osteotomy cuts were rarely above the superior alar crease (2.9%) and never above the non-cleft superior ala.
• A "high osteotomy" defined as 20.36 mm from the pyriform aperture base was calculated as achievable with 95% confidence.

Conclusions:

• Consistently achieving a "high osteotomy" is difficult due to the variable relationship between the superior alar crease and the inferior turbinate.
• Surgical planning must account for individual patient anatomy to optimize Le Fort I osteotomy placement in CLP patients.