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Bone Grafting in Le Fort I Osteotomies: Multi-Institutional Data Analysis of Early Outcomes and Risk Factors
Simon Bigus1, Leonard Knoedler1,2, Michael Alfertshofer1
1Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Background:
The Le Fort I osteotomy is a standard approach for treating the maxilla in orthognathic surgery. Achieving stable ossification, particularly in cases requiring significant movements, can be clinically challenging and may compromise the ossification process. Despite the clinical significance of this issue, there remains a lack of robust multicenter studies directly comparing outcomes of Le Fort I osteotomies performed with versus without bone grafting (BG).
Methods:
In this study, the authors accessed the ACS-NSQIP database from 2008 to 2023 to identify patients who underwent isolated surgical Le Fort I osteotomy with and without BG. Collected data included demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes.
Results:
Of 418 patients who underwent an isolated Le Fort I osteotomy, 95 patients (22.7%) underwent augmentation of the gap using BG, while 323 patients (77.3%) underwent surgery without BG. Overall, 13 (4.0%) non-BG and 7 (7.4%) BG patients experienced any complication (P=0.88). In a multivariable analysis of all study cases, longer hospital stays (P<0.01) were identified as an independent risk factor for the occurrence of any postoperative complications, whereas higher BMI (P=0.02) and obesity (P=0.04) were found to be independent risk factors for the occurrence of surgical complications.
Conclusion:
The Le Fort I osteotomy is an overall safe procedure. In this study, the use of BG did not appear to increase the risk of postoperative complications compared with procedures performed without BG. Identified risk factors for postoperative complications are prolonged hospital stays, higher BMI, and obesity.
