Sunday, October 10, 2004 - 11:00 AM
5802

Le Fort I Internal Distraction Provides Improved Outcomes in Cleft Patients With Severe Maxillary Deficiency

Joubin S. Gabbay, MD, Rabin Nikjoo, MD, Anand Kumar, MD, Amir Tahernia, MD, Catherine O'Hara, BA, Manisha Sisodia, BS, Jose Garri, MD, Libby Wilson, MD, Henry K. Kawamoto, MD, DDS, and James P. Bradley, MD.

Introduction: severe maxillary deficiency of cleft lip and palate patients with traditional orthognathic correction may result in undercorrection, relapse or increased revisionary procedures. To see if Le Fort I internal distraction osteogenesis offers improved results, we compared this technique to traditional orthognathic treatment using serial evaluations and radiographs. Methods: Nonsyndromic cleft patients with severe maxillary deficiency (10mm) and normal mandibular growth were divided into 2 equal management groups: 1) Traditional Le Fort I advancement and 2) Le Fort I internal distraction (n=40). Preoperative, postoperative, and follow-up (mean 3.5 years) evaluations were based on dental casts, photographs, cephalograms and speech evaluations (Pittsburgh speech score, <3-5 was equivalent to velopharyngeal insufficiency (VPI). Results: Patients with severe maxillary deficiency and Le Fort I advancement (Group 1) had the following (means): SNA preop=75.7o, postop=81.2o and follow-up=78.8o; preoperative to follow-up FH-x-axis (horizontal) change was 8.4mm; FH-y-axis (vertical) change was –1.3mm; 38% (5/13) had a follow-up class I occlusion, 8 needed readvancement; and 9 had VPI. Patients with severe maxillary deficiency and Le Fort I internal distraction (Group 2) had the following: SNA preop=74.2o, postop=85.0o and follow-up=84.2o; preoperative to follow-up FH-x-axis (horizontal) change was 15.3mm; FH-y-axis (vertical) change was –1.0mm; 77% (10/13) had a follow-up class I occlusion, 4 needed reoperation; and 3 had VPI. For patients with severe maxillary deficiency, distraction cases showed an increase in SNA of 10.8o compared to 5.5o for traditional advancement. Horizontal advancement was 6.9mm greater to follow-up distraction cases compared to traditional cases. Conclusions: From these data we concluded, Le Fort I internal distraction for severe cleft maxillary deficiency leads to better dental occlusion, less relapse and better speech results. A follow-up study with quantitative serial speech evaluations (nasoendoscopy) is warranted.
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