Postoperative Complications Following LeFort 1 Maxillary Advancement Surgery in Cleft Palate Patients

Abstract

Objective: To investigate the postoperative complication rates of LeFort 1 maxillary advancement surgery in cleft patients when performed by a single surgeon over a 5-year period. Design: A retrospective case note review of 79 cleft palate patients. Setting: All surgery was performed by a single oral and maxillofacial surgeon in a tertiary care center. Participants: All cleft palate patients over 17 years of age who opted for surgical correction of maxillary hypoplasia with a LeFort 1 between 2010 and 2015. Patients required full surgical and clinical records. Interventions: Complete surgical advancement of the maxilla ranging from 2.0 to 18.0 mm performed by conventional osteotomies (87%) or distraction osteogenesis (13%). Main Outcome Measure(s): Postoperative patient- and clinician-reported complications at set-interval follow-up appointments. Results: Twenty-one patients (26.58%) reported no complications; 11 postoperative complications were identified in the remaining cohort. Temporary paresthesia of the infraorbital nerve was the most common complication (53.16%) followed by infection (13.92%). Other complications included relapse (11.39%), maxillary instability (6.33%), velopharyngeal impairment (6.33%), nasal obstruction (5.06%), chronic sinusitis (3.80%), bony dehiscence (1.27%), gingival necrosis (1.27%), partial necrosis of the maxilla (1.27%), and loss of tooth vitality (1.27%). Conclusions: LeFort 1 maxillary advancement surgery in cleft palate patients is associated with a wide range of postoperative complications, most commonly temporary paresthesia of the infraorbital nerve. Detailed, informed consent is essential prior to surgery.