Clinical Application Of Le Fort Ⅰ Osteotomy With Segmental Distraction Osteogenesis For Correction Of Adult Maxillary Retrusion In Patients With Cleft Lip And Palate

Objective:To evaluate the clinical outcomes of maxillary retrusion in patients with cleft lip and palate by Le Fort Ⅰ osteotomy with segmental distraction osteogenesis.Methods:In this study,10 patients(9 men and 1 woman)with maxillary retrusion secondary to cleft lip and palate(4 with bilateral cleft lip and palate and 6 with unilateral cleft lip and palate)performed Le Fort Ⅰ osteotomy with segmental distraction osteogenesis at Center for Cleft Lip and Palate Treatment,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,from October 2013 to May 2018,with the mean age of 19.3 years old(from 16 to 28 years old).Lateral cephalometric,intraoral photograph and head CT were taken to evaluate the improvement of maxillary retrusion,upper dental arch constriction and crowded dentition.All statistical analyses were conducted by IBM SPSS Statistics Software,version 26.0.The paired sample t test was used and the levels of significance were set at p<0.05.Results:All the 10 patients were completed with the Le Fort Ⅰ osteotomy with segmental distraction osteogenesis successfully.No infection and other complications were found.Maxilla convexity:The position of point A moved forward 6.97± 1.67mm on average in horizontal direction after 1 year,the average increase of SNA was 6.22±3.82 degree,the average decrease of SNB was 1.97±2.20 degree,the average increase of ANB was 8.76±3.43 degree.Dental crowding:the average increase of dental crowding was 12.90±3.97mm before surgery and the average increase of maxilla length was 8.52±1.62mm after surgery.Maxilla volume:The average increase of maxilla volume was 1969.84mm3mm3;Dental arch width:The average increase of M3W was 1.20±0.49,the average increase of M4W was 1.22±0.60,the average increase of M5W was 1.99± 1.21,the average increase of M6W was 0.61±0.24,the average increase of M7W was 0.47±0.26.Conclusion:Le Fort Ⅰ osteotomy with segmental distraction osteogenesis is an effective approach for correcting adult maxillary retrusion in patients with cleft lip and palate and can improve the facial profile and functional occlusion simultaneously.