Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients

Abstract

BackgroundOrthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery).MethodsTwenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared.ResultsThe mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'.ConclusionsPatients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

Cephalometric Evaluation of Facial Soft Tissue Changes after Orthodontics and Bimaxillary Orthognathic Surgery Treatment in Patients with Skeletal Class III Discrepancy

“…In our study, post-operative upper lip to E-line distance was 4.18 mm which was in the normal range. In Yun et al (2015) study about two-jaw surgeries in cleft patients, the mean minimal distance between E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery (17). This result is similar to our findings and Kerr and Lin study (1998) that announced upper lip to Eline distance decreased after surgery, significantly (18).…”

“…The mean nasolabial angle was 72.7°before surgery. It was increased to 88.7°after surgery in Yun study (17). According to Ghassemi et al naso-labial angle was decreased by 9.5°after surgery (P < 0.001) (14).…”

Cirurgia Ortognática em paciente com Fissura Labiopalatina: Relato de caso

“…Essa sequela impede o crescimento maxilar adequado, resultando em hipoplasia maxilar e deformidade dentofacial do tipo Classe III de Angle (LOPES et al, 2015;LURENTT et al, 2012;YAMAGUCHI, LONIC, LO, 2016;YUN et al, 2015).…”

“…Nesses casos o tratamento ortodôntico isolado não é suficiente para correção do problema e a cirurgia ortognática deve ser associada a fim corrigir discrepâncias maxilomandibulares ao fim do crescimento facial possibilitando uma oclusão estável e o reestabelecimento de padrões funcionais e harmonia facial (FREITAS et al, 2012;LOPES et al, 2015;YUN et al, 2015).…”

Análise de recidiva após osteotomia Le Fort I para avanço maxilar em pacientes com fissura de lábio e palato

“…Trabalhos anteriores avaliam de forma distinta cefalometrias digitais (KUMAR et al, 2013;YUN et al, 2015) e modelos digitalizados (OLIVEIRA et al, 2007;WUTZL et al, 2009;CUPERUS et al, 2012) em pacientes sem síndromes ou anomalias relacionadas. Em pacientes com fissura labiopalatina há carência de estudos que analisem a ocorrência de recidiva óssea e dentária e suas implicações no planejamento e tratamento das discrepânicas maxilo-mandibulares, entretanto trabalhos que mostram a reprodutibilildade e validade dos modelos digitalizados tem se mostrado cada vez mais presentes na literatura (ASQUITH et al, 2012) Com base nestes relatos, o objetivo do presente trabalho foi identificar a presença ou não de recidiva após cirurgia ortognática, para avanço maxilar, através da osteotomia maxilar Le Fort I, por meio de avaliações de cefalometrias digitais e modelos digitalizados em pacientes com fissura de lábio e palato.…”