Relationship Between Expansion Magnitude and Relapse in Multi-Segment Le Fort I Osteotomy: A Retrospective Cohort...

Maxillary transverse deficiency is commonly addressed through multisegment Le Fort I osteotomies. Whether greater expansion magnitudes result in greater relapse remains uncertain, because the existing literature primarily reports relapse of procedures with dental expansion of <4 mm.

To measure the association between magnitude of expansion and relapse among patients undergoing multisegment Le Fort I osteotomies.

This retrospective cohort study included subjects presenting to a private oral and maxillofacial surgery practice in Santa Barbara, CA, for multisegment Le Fort I osteotomies for correction of class II or class III skeletal deformities. Inclusion criteria were the presence of all first molars and the availability of CBCT images taken at the surgeon's office 2 to 4 days preoperatively and at 2 weeks, 8 weeks, and at least 6 months postoperatively, after orthodontic treatment. Exclusion criteria were a history of skeletal deformities resulting from trauma, orofacial clefts, degenerative temporomandibular joint disorders, or previous orthognathic surgery.

The primary predictor variable was the magnitude of surgical maxillary molar expansion (<4 mm vs ≥4 mm).

The main outcome variables were relapse in maxillary intercanine and intermolar widths. Skeletal relapse was assessed by similar comparisons for piriform aperture and greater palatine foramen widths.

Covariates included age, sex, grouping according to molar expansion, and first molar buccolingual angulation.

Changes in measurements from preoperative (T0), 2-week postoperative (T1), 8-week (T2), and longest term (T3) follow-ups were compared between groups using paired t tests and analysis of variance, with statistical significance set at P < .05. Time-to-event analyses were conducted to evaluate relapse-free survival following maxillary expansion.

The <4-mm expansion group, including 31 subjects (22 females) with a mean age of 26.6 years, demonstrated a significant relapse of 0.71 mm as related to a mean expansion of 1.33 mm in intermolar width (55%, P < .001). The ≥4-mm group had 32 subjects (21 females) with a mean age of 25.6 years and had a mean of 1.24 mm relapse out of 5.20-mm expansion (23%) (P < .001). Relapse in the GPF width for both groups was insignificant. Relapse was significantly correlated with expansion. Molar relapse and expansion, however, occurred during postoperative orthodontic treatment and may not reflect surgical instability. Kaplan-Meier analysis demonstrated a significantly shorter relapse-free survival among patients undergoing ≥4-mm expansion compared with those undergoing <4-mm expansion. In univariable Cox regression analyses, expansion magnitude was significantly associated with time to relapse, with patients undergoing <4-mm expansion demonstrating a lower hazard of ≥30% relapse compared with those undergoing ≥4-mm expansion.

Clinically significant relapse (exceeding 30%) was more frequent and occurred earlier when the surgical expansion of the maxillary first molar exceeded 4 mm. However, postoperative orthodontic treatment may have influenced the molar position and the intermolar width. In addition, there was no difference in relapse of the secondary outcomes (intercanine, inter-piriform aperture, and inter-GPF), observed between the two groups after the Holm correction.