Comparison of Maxillary Distraction Osteogenesis and Conventional Orthognathic Osteotomy: A Systematic Review

Maxillary hypoplasia, affecting 0.3% of the US population and nearly 25% of patients with cleft lip and/or palate (CLP), often results in Class III malocclusion with significant functional and esthetic challenges. Treatment options include LeFort I distraction osteogenesis (DO) and conventional osteotomy (CO), but reported outcomes vary widely. A systematic review of PubMed, Embase, Scopus, and CINAHL identified 17 studies (6 randomized controlled trials, 11 retrospective cohort studies) from 5076 screened. Outcomes assessed included skeletal relapse, speech changes, velopharyngeal insufficiency (VPI), soft tissue adaptations, and complications. Study quality was evaluated using the Newcastle-Ottawa scale and Cochrane risk-of-bias tool. Findings showed no significant differences in skeletal relapse between DO and CO. Speech and VPI outcomes were comparable, with deterioration in 10% to 45% of DO patients and 22.2% to 81.8% of CO patients. DO provide superior soft tissue improvements, particularly in nasal and lip landmarks. Complication rates ranged from 5% to 20% for DO and 21% to 22.2% for CO. Overall, evidence comparing DO and CO remains limited and inconsistent, preventing definitive conclusions on skeletal stability, speech outcomes, VPI risk, and complications. While DO may offer better soft tissue outcomes, it shares high complication rates and patient dissatisfaction. Further research is essential.