Effect of maxillary distraction osteogenesis and LeFort-1 advancement orthognathic surgery on soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios among patients with complete unilateral cleft lip and palate

Author:

Rajagopalan Anjana1,Verma Sanjeev1,Kumar Vinay1,Verma Raj Kumar1,Singh Satinder Pal1,Rattan Vidya2

Affiliation:

1. Department of Orthodontics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

2. Unit of Oral and Maxillofacial Surgery, Oral Health Sciences Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India,

Abstract

Objectives: The objective of this study was to compare the soft-tissue thickness and anterior soft-tissue to hard-tissue movement ratios in patients with unilateral cleft lip and/or palate (UCLP) following maxillary distraction osteogenesis using rigid external distractor device and maxillary advancement at LeFort I level using lateral cephalograms. Material and Methods: This retrospective study was conducted on 20 patients with UCLP who underwent either LeFort I maxillary advancement or maxillary distraction osteogenesis. Non-syndromic patients with complete UCLP anomalies and skeletal class III patterns due to maxillary hypoplasia were included in the study. The patients with a pre-surgical negative overjet of ≥5 mm were treated by maxillary distraction osteogenesis, while a negative overjet of <5 mm was managed with maxillary advancement orthognathic surgery. The growth completion in all the patients was assessed using the cervical vertebrae maturation index (CS 6) on a lateral cephalogram. The lateral cephalograms taken before surgery at (T0) and after a minimum interval of six months (T1) of surgery were assessed for changes in soft-tissue thickness and hard-tissue to soft-tissue movement ratios among the two groups. Paired t-test was used to compare the mean values obtained within the same group at two different time intervals. Unpaired t-test was used to compare mean values between the Groups 1 and 2. Pearson’s correlation coefficient (r) test was used to assess the associations between the mean changes in hard- and soft-tissue variables. Results: Group 1 showed significantly greater maxillary advancement compared to Group 2 with a mean difference of 5.80 mm at Point A and 7.65 mm at the upper incisal edge. Soft-tissue thickness decreased significantly after advancement in Group 1 at subnasale (P < 0.05), labrale superius, stomion, and labrale inferius (P < 0.01) and at subnasale (P < 0.05), stomion and labrale inferius (P < 0.01) in Group 2. There was a significantly strong correlation between the hard- and soft-tissue movement in sagittal plane in both Group 1 and Group 2. In Groups 1 and 2, a statistical highly significant strong positive correlation was found between vertical change in dU1 to soft-tissue dLs and dStms. In Group 2, a statistical highly significant strong positive correlation was found between vertical change in dA to soft-tissue dC and dStms. Conclusion: The soft-tissue thickness reduced in patients with UCLP after maxillary advancement in both groups. The soft tissue followed the hard tissue in both groups. There was a greater downward movement of the maxillary base and soft-tissue lengthening in Group 1 compared to Group 2.

Publisher

Scientific Scholar

Reference26 articles.

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2. Stability after surgical-orthodontic correction of skeletal Class III malocclusion. 2. Maxillary advancement;Proffit;Int J Adult Orthodon Orthognath Surg,1991

3. The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla; Part 1. Stability resulting from non-bone grafted rigid fixation;Hoffman;Br J Oral Maxillofac Surg,2004

4. Long-term skeletal stability after rigid fixation of Le Fort I osteotomies with advancements;Louis;Int J Oral Maxillofac Surg,1993

5. Distraction osteogenesis of the human craniofacial skeleton: Initial experience with a new distraction system;Cohen;J Craniofac Surg,1995

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