Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

Abstract

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

LeFort III/I for Beckwith–Wiedemann Syndrome: A Case Report

“…12 A maxillary advancement of greater than 8 mm is considered unstable by many centers and a large LeFort I advancement (>15 mm) would risk the appearance of bimaxillary protrusion. 13,14 Additionally, maxillary advancement may lead to pharyngeal incompetence and postoperative speech problems. 15,16 Thus, this patient was indicated for a large midface advancement which would include a LeFort III and then LeFort I procedure.…”

Does the Rigid External Distraction Device Alter Maxillary Pitch in Cleft Maxillary Distraction?

“…Wangsrimongkol et al recently described a series of 51 cleft patients who underwent orthognathic Le Fort I maxillary advancement. 25,29 All patients underwent Le Fort I advancement with inferior and anterior positioning with CW rotation. Their group on average required vertical lengthening of 2 mm at the A-point and demonstrated a mean of 2° CW rotation of the palatal plane (SN-PP).…”

“…This is consistent with the findings of Doucet et al, Baek et al, and Wangsrimongkol et al, however, inconsistent with the CW rotation reported by Figueroa. 15,24,25,29…”

Coverage Gaps and Inconsistencies: The Landscape of Insurance Coverage for Orthognathic Surgery in the United States

“…These include skeletal malocclusion, airway correction for obstructive sleep apnea (OSA), treatment of malocclusion-related temporomandibular joint dysfunction (TMD), treatment of cleft lip and palate, and to improve facial esthetics. 2-6…”

“…These include skeletal malocclusion, airway correction for obstructive sleep apnea (OSA), treatment of malocclusion-related temporomandibular joint dysfunction (TMD), treatment of cleft lip and palate, and to improve facial esthetics. [2][3][4][5][6] However, patient access to orthognathic surgery in the United States may be limited by health insurance and inconsistent coverage criteria. Many patients with private health insurance are denied medically-necessary procedures due to inconsistencies between guidelines set by medical authorities and criteria set by insurance providers.…”