[Transpalatal modified Le Fort I osteotomy for correction of maxillary hypoplasia in cleft lip and palate patients: a preliminary clinical application]

Abstract

Objective: To evaluate the surgical corrective results of maxillary hypoplasia in patients with cleft lip and palate withtranspalatal modified Le Fort I osteotomy.

Methods: In the study, 11 patients (4 women, and 7 men) with maxillary hypoplasia secondary to cleft lip and palate underwent transpalatal modified Le Fort I osteotomy at Peking University School of Stomatology from Jan. 2012 to Dec. 2013,with the mean age of 21 years ( from 18 to 27 years), Bilateral sagittal split ramus osteotomy (BSSRO)and genioplasty were performed simultaneously in 9 of them for better appearance and functional occlusion. Lateral cephalometric radiographs were taken and traced before surgery, immediately after surgery and 6 months after surgery. The position of subspinale (A) on horizontal direction, the angle of sella-nasion-subsipmale (SNA) and the angle of sella-nasion-supramental (SNB) were collected and analyzed to evaluate the results.

Results: All the patients were uneventful with transpalatal modified Le Fort I osteotomy. All of them had a better profile and a satisfactory occlusionafter operation.The position of A was moved forward (6.6±1.1) mm on average in horizontal direction when surgery was completed, and maintained (6.0±1.2) mm on average 6 months after surgery. The average of SNA was 75.9°±2.8° before surgery,81.6°±8.6° immediately after surgery, and maintained 81.0°±2.6° 6 months after surgery. The average of SNB was 82.6°±3.7° before surgery, 78.0°±2.4° immediately after surgery, and maintained 78.5°±2.4° 6 months after surgery.

Conclusion: The maxillary hypoplasia in cleft lip and palate patients can be successfully corrected with transpalatal modified Le Fort I osteotomy and the functional occlusion can be achieved simultaneously. The effect of deformity correction was satisfactory. Transpalatal modified Le Fort I osteotomy can move maxilla more sufficiently, especially applicable for the patient with severe palatal scars preoperatively.