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Examining Volumetric Expansion After Le Fort I Advancement for Maxillary Hypoplasia in Cleft Patients: A Cohort Comparison Study Between Single and Two Piece Le Fort 1 Osteotomy
Lino F. Miele, MD, MS, S. Alex Rottgers, MD, Darren Smith, MD, Oluwaseun A. Adetayo, MD, Zoe M. MacIsaac, MD, Anand Kumar, MD
University of Pittsburgh
2013-03-13
Presenter: Lino F. Miele
Affidavit:
All of the above work is the original work of Lino F. Miele, MD and coauthors. The majority of the work was performed by Lino F. Miele, MD.
Director Name: Joseph E. Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Midface volumetric and soft tissue changes after Le Fort 1(LF1) advancement for cleft-related maxillary hypoplasia remain understudied. The aim of this study is to analyze facial volumetric and soft tissue changes between 1-and 2-piece LF1 osteotomies.
Methods: A 24-month retrospective cohort study correlating cephalometric and volumetric changes in cleft palate patients with maxillary hypoplasia treated with LF1 osteotomy(1-or 2-piece) was performed. Cephalometric parameters(overjet,overbite,soft tissue advancement) and volumetric changes of the midface using 3D stereo photogrammetric imaging(Vectra XT Imaging System,Canfield Scientific,Inc.,Fairfield,NJ) were analyzed. Advancement distances at subnasale(SN),labium superius(LS) and stomion(STO) and volume change of the midface(infraorbitale to oral commissure) were evaluated.
Results: 11 patients(7 male,4 female) who met inclusion criteria underwent 11 total LF1 advancements(Group 1,1-piece n=7; Group 2,2-piece,n=4). All were non-syndromic with cleft-related maxillary hypoplasia and class III malocclusion. The average cephalometric advancement at maxilla central incisor(MCI) edge was 7.0(5.1-8.5) mm in Group 1 and 5.4(3.3-7.4) mm in Group 2(p=0.058). The average soft tissue point advancement was SN 5.7 mm,LS 7.1 mm and STO 6.1 mm in Group 1 and SN 4.2 mm,LS 3.4 mm and STO 3.7 mm in Group 2(p=0.34,0.01,0.02). The average volumetric change in Group 1 was 14.1 ml(2ml/mm advancement) and 9.0 ml(1.67 ml/mm advancement) in Group 2(p=0.14).
Conclusions: Midface advancement was consistently and significantly expanded at labium superius(LS) and stomion(STO) using 1-piece. Soft tissue advancement was less than calculated cephalometric advancement by 13%(1-piece) and 32%(2-piece). 1-piece LF1 advancement for maxillary hypoplasia in cleft patients yields predictable midface soft tissue advancement and volumetric expansion.
