Cephalometric Comparison of Le Fort I Osteotomy in Growing and Non-Growing Patients With Clefts: A Retrospective Study

Objective: To cephalometrically compare craniofacial morphology and maxillary advancement in growing versus non-growing patients with clefts undergoing Le Fort I osteotomy. Design: Retrospective cohort study. Setting: All patients underwent maxillary osteotomy at a single tertiary hospital. Patients: The Pre-Growth-Completion group (PreGC) comprised 28 growing patients (18 males, 10 females; 9 BCLP, 18 UCLP, 1 CP) with a mean age at surgery of 13.5 years (SD = 1.22; range, 11.5-16.7). The Post-Growth-Completion group (PostGC) comprised 59 patients (28 males, 31 females; 15 BCLP, 23 UCLP, 21 CP) with a mean age at surgery of 18.3 years (SD = 4.38; range, 14.5-45.3). Patients with syndromes and those undergoing bimaxillary osteotomies were excluded. Interventions: Each patient underwent Le Fort I osteotomy. Osteotomies were fixed with patient-specific implants or miniplates. Main Outcome Measures: Cephalometric analysis was performed comparing preoperative lateral cephalometric radiographs or CT scans and immediate postoperative lateral cephalometric radiographs. Results: Patients in PreGC group had more severe preoperative maxillary hypoplasia (SNA 74.2° vs 77.0°, P = .007; ANB −5.2° vs −1.9°, P = .0001), but no significant differences were observed postoperatively (SNA 80.7° vs 78.9°, ANB 2.7° vs 3.9°). Maxillary horizontal advancement was greater in the PreGC group (point A 6.4 mm vs 3.2 mm; P = .00002). Conclusions: Patients undergoing early Le Fort I osteotomy had more severe preoperative maxillary hypoplasia, required greater horizontal advancements, yet achieved significant corrections comparable to patients treated later. However, early osteotomy in growing patients may be considered a 2-stage approach as secondary correction is often required after growth is complete.