Nasal Changes After Le Fort I Osteotomy in Individuals With Cleft Lip and Palate: A Systematic Review

ObjectiveTo systematically evaluate reported nasal morphological changes following Le Fort I osteotomy in individuals with cleft lip and palate (CLP).DesignSystematic review.SettingNot applicable.ParticipantsAdolescents (>16 years) and adults with nonsyndromic CLP undergoing maxillary orthognathic surgery.InterventionsLe Fort I osteotomy, performed either in isolation or in combination with bilateral sagittal split osteotomy.Main Outcome MeasuresPostoperative nasal morphological changes, including alar base width, nasal tip projection, nasal length, and nasolabial angle. Additional synthesized outcomes included alar symmetry and soft tissue response ratios when available.ResultsEight observational studies (one prospective, one cross-sectional, and six retrospective), including 201 individuals with CLP, were analyzed. Risk of bias was high in five studies and moderate in three. Across heterogeneous study designs and assessment methods, Le Fort I osteotomy was associated with improvements in alar symmetry and increases in the nasolabial angle (up to +16.0°). Alar widening (up to 3.0 mm) and variable changes in nasal tip projection, ranging from -2.22 to +2.40 mm, were also reported. Soft tissue responses varied substantially, with the nasal base following approximately 55% to 57% of maxillary advancement, nasal tip response ranging from -0.36 to +0.28 mm/mm of maxillary advancement, and nasolabial angle changes reaching 2.61° per millimeter of advancement.ConclusionsLe Fort I osteotomy is associated with postoperative nasal morphological changes in individuals with CLP. Improvements in alar symmetry and nasolabial angle were reported, although alar widening and variable changes in nasal tip projection and nasal length were also observed. Given methodological heterogeneity and moderate-to-high risk of bias, findings should be interpreted cautiously.