A Quantitative Assessment of Maxillary Bone Density and Thickness in Cleft Versus Noncleft Patients Undergoing Le Fort I Osteotomy

Background: Patients with cleft lip and palate (CLP) experience higher complication rates during Le Fort I osteotomy, particularly during pterygomaxillary disjunction. Although anatomic differences in cleft maxillae are well recognized, quantitative characterization of bone quality at critical osteotomy sites remains limited. This study compares cortical thickness, trabecular bone density, and palatal morphology in patients with CLP and noncleft controls. Methods: A retrospective review conducted between 2020 and 2023 identified patients who underwent Le Fort I osteotomy and had preoperative maxillofacial computed tomography. Twelve patients with CLP were matched to 12 noncleft controls with regard to age, sex, and occlusal class. Three-dimensional reconstructions were used to measure cortical thickness and trabecular bone density (HU) at the nasomaxillary buttress (NMB), zygomaticomaxillary buttress (ZMB), and pterygomaxillary junction (PMJ). Palatal dimensions were also assessed. Results: Compared with controls, patients with CLP demonstrated reduced cortical thickness at both the NMB and PMJ, with significantly decreased PMJ cortical width (4.234±1.086 versus 5.433±1.209 mm; P <0.05). Trabecular bone density was higher at the NMB (725.5±108.3 versus 596.1±118.5 HU; P <0.05) and ZMB in the CLP cohort. Cleft-sided analyses revealed higher trabecular bone density and reduced cortical thickness. Patients with CLP exhibited decreased intercanine width, palatal length, and palatal height ( P <0.05). Conclusions: Patients with CLP demonstrate thinner cortical bone, increased trabecular density, and reduced palatal dimensions at key Le Fort I osteotomy sites. These structural differences likely reflect scar-mediated remodeling and altered biomechanics, contributing to unpredictable fracture patterns. Quantitative assessment of bone quality may improve surgical planning and safety in this population.