Is subcranial Le Fort III plus Le Fort I osteotomy stable?

Abstract

The purpose of this study was to test whether associated subcranial Le Fort III (sLF III) and Le Fort I (LF I) osteotomies are stable after large advancements of the middle third of the face and maxilla. The authors designed a retrospective study and enrolled a sample of consecutive patients with midface hypoplasia treated with associated sLF III and LF I osteotomies in this IRB-approved study between September 2013 and February 2015. To test whether the long-term stability was satisfactory, the authors compared cephalometric changes from immediately after surgery to 18 months after surgery taken from multi-slice computed tomography using two different third-party imaging software programs. Statistical significance was set as P ≤ 0.05. The sample comprised 11 patients (mean age 23.84 ± 4.17 yr; 54% men). The mean advancement of the upper incisor immediately after surgery was 10.03 ± 1.6 mm. After 18 months, the position of the upper incisor did not vary significantly (10.18 ± 2.35 mm). All other cephalometric landmarks did not present statistically significant differences between immediately after and 18 months after surgery, with horizontal and vertical variations of less than one millimetre. This study supports that sLF III and LF I osteotomies are effective in maintaining stable horizontal and vertical skeletal positioning after surgery.

Simultaneous Le Fort III and Le Fort I Osteotomy: Surgical Outcomes and Clinical Parameters

“…As the muscles holding the maxilla are not yet stretched, a subsequent LF I osteotomy can be completed until the muscles and skin are stretched resulting in a net larger advancement that can be accomplished with a LF I advancement alone. 9 Contrary to this study, Schmitz et al, 21 demonstrated more vertical relapse than anteroposterior relapse measured at A point and central incisor tip at 1 year post surgery.…”

“…They hypothesized that LF III/I advancement is more stable for larger horizontal movements compared with LF I alone because a LF III osteotomy will advance the pharyngeal and palatal muscles that insert to the maxilla. As the muscles holding the maxilla are not yet stretched, a subsequent LF I osteotomy can be completed until the muscles and skin are stretched resulting in a net larger advancement that can be accomplished with a LF I advancement alone 9. Contrary to this study, Schmitz et al,21 demonstrated more vertical relapse than anteroposterior relapse measured at A point and central incisor tip at 1 year post surgery.…”

“…Simultaneous LF III/I osteotomies allow optimization of the midface position through the LF III osteotomy while addressing residual occlusal discrepancies with the LF I osteotomy, with no major complications reported. 8 Lima et al 9 reported the osteotomic variant being effective for maintaining stable horizontal and vertical skeletal positions after surgery in nonsyndromic patients; however, there is insufficient data for mature, syndromic craniofacial patients. Specifically, there is currently no objective measurements or long-term studies published for this patient population.…”