11.0: Thursday, March 17, 2005

Long-Term Comparative Analysis of Le Fort I Osteotomy Fixation in the Cleft Population: Titanium versus Resorbable Plates

Russell Reid, MD, PhD and Pravin K. Patel, MD.

PURPOSE: This retrospective study evaluated the effectiveness of resorbable plate and screw fixation for maxillary osteotomy compared to titanium systems in cleft patients.

PATIENTS AND METHODS: Consecutive cleft lip and palate patients underwent Le Fort I maxillary osteotomies and advancement that were fixed using 2.0-mm L-shaped copolymeric poly L-lactic acid/polyglycolic acid (PLLA/PGA) or standard titanium plates and screws. Prefabricated acrylic splints were used with interdental elastic fixation for 2 weeks. Guidance elastics were applied for a subsequent 4 weeks. Patients were evaluated by pre- and postoperative cephalometric analysis to determine long-term maintenance of advancement. Major and minor complications were analyzed.

RESULTS: Patients were age- and sex-matched. The average maxillary advancement was similar between the two groups. Cephalometric analysis of these two groups at varying time points displayed no differences in the maintenance of advancement or relapse rates. The reoperative rate was equivalent. Only resorbable fixation was associated with sterile seroma formation and allergic reactions.

CONCLUSIONS: These findings suggest that resorbable plate fixation is a viable alternative to standard metallic fixation techniques for LeFort I maxillary advancement in cleft patients in which moderate segmental advancements are performed. Less reactive materials will increase use of these systems in craniofacial surgery.