Skeletal Stability and Relapse Patterns after Le Fort I Osteotomy Using Miniplate Fixation in Patients with Isolated Cleft Palate

We present a series of 14 consecutive isolated cleft palate patients aged 17 to 25 years (mean 19 years) who underwent Le Fort 1 maxillary advancement fixed with miniplates by the senior author (Posnick) over the period 1987–1991. Ten of the patients underwent autogenous bone grafting; all were stabilized intraoperatively with four miniplates, a prefabricated acrylic splint, and intermaxillary fixation. The patients were analyzed to determine amount and timing of horizontal and anterior and posterior vertical relapse, correlation between advancement and relapse, effect of a pharyngoplasty in place at time of osteotomy, effect of performing multiple jaw procedures, and maintenance of overjet and overbite. Tracings of preoperative and serial postoperative lateral cephalograms (immediate, 6 to 8 weeks, and 1 year) were analyzed to calculate horizontal and vertical maxillary changes and the amount of overjet and overbite maintained. Clinical follow-up ranged from 1.5 to 5.5 years (mean 2.5 years). No significant difference was seen in vertical or horizontal change or relapse between patients who had maxillary surgery alone (n = 10) and those who had operations in both jaws (n = 4), nor did outcome vary significantly for those who had a pharyngoplasty in place (n = 8) at the time of their Le Fort I osteotomy. The mean “effective” maxillary advancement for the group was 6.4 mm, with 5.4 mm maintained 1 year later (mean relapse 1.0 mm). The mean anterior vertical change of the maxilla was 2.0 mm, with 1.4 mm maintained after 1 year (mean relapse 0.6 mm), while the mean posterior vertical change was 2.7 mm, with 1.9 mm maintained 1 year later (mean relapse 0.8 mm). All patients maintained a positive overjet and overbite. The extent of skeletal relapse in this series fell within a range small enough that problems could be managed effectively through a combination of planned surgical overcorrection and orthodontic treatment.