Maxillary advancement with conventional orthognathic surgery in patients with cleft lip and palate: is it a stable technique?

Abstract

Purpose: To evaluate the long-term skeletal stability after maxillary surgical advancement with conventional Le Fort I osteotomy in patients with cleft lip and palate by a systematic review of the published data.

Materials and methods: Electronic databases, "gray literature," and reference list searches were conducted. The inclusion criteria were the stability of maxillary surgical advancement with conventional Le Fort I osteotomy fixed with plates and assessed at the post-treatment follow-up 1 year or more postoperatively in patients with cleft lip and/or palate. Full reports were retrieved from abstracts or titles that appeared to meet the inclusion criteria or lacked sufficient detail for immediate exclusion. Once full reports were collected, they were again reviewed, considering more detailed inclusion criteria for a final selection decision. A methodologic quality assessment tool was used. The quantity and quality of the obtained data precluded a meta-analytic approach.

Results: A total of 25 abstracts/titles met the initial search criteria, and 10 studies were finally selected. The overall methodologic quality scores were high for only 1 randomized clinical trial. After maxillary advancement with Le Fort I in patients with cleft lip and palate, the long-term horizontal relapse at the A-point was 20% to 30% in 4 studies and 30% to 40% in 3 studies. In addition, vertical relapse was more than 50% in 4 studies. The study judged as a high-quality study reported a 37% rate of horizontal relapse and a 65% rate of vertical relapse at the A-point.

Conclusions: Current evidence suggests maxillary surgical advancement with conventional Le Fort I osteotomy in patients with cleft lip and palate appears to show a moderate relapse rate in the horizontal plane and a high relapse rate in the vertical plane.