SKELETAL STABILITY AFTER LEFORT-I MAXILLARY ADVANCEMENT IN PATIENTS WITH UNILATERAL CLEFT-LIP AND PALATE

Outcomes in 30 adults and adolescents judged skele-tally mature who had unilateral cleft lip and palate and underwent Le Fort I advancement were investigated to determine amount and timing of relapse, correlation between advancement and relapse, effect of performing multiple jaw procedures, effect of different types of bone grafts, effect of pharyngoplasty in place at the time of osteotomy, and effectiveness of various methods of internal fixation. Tracings of preoperative and serial postoperative lateral cephalograms were digitized to calculate horizontal and vertical maxillary changes. No significant difference in outcome was seen between patients who had maxillary surgery alone and those who had operations on both jaws, nor did the outcome vary significantly with the type of autogenous bone graft used or the segmentalization of the Le Fort osteotomy. Mean “effective” advancement was greater immediately and 2 years after surgery in those patients who did not have a pharyngoplasty in place before the operation. Advancement also was greater immediately and after 2 years in the miniplate fixation group than in patients with direct-wire fixation. Mean downward (vertical) displacement was 2.6 mm with a relapse of 1.4 mm after 2 years. Amounts of relapse and of advancement or displacement did not correlate significantly. © 1990 American Society of Plastic Surgeons.