Additional orthognathic surgery following Le Fort III and monobloc advancement

• Published in: International journal of oral and maxillofacial surgery 2011-07, Vol.40 (7), p.679-684
• Main Authors: Nout, E, Koudstaal, M.J, Wolvius, E.B, Van der Wal, K.G.H
• Format: Article
• Language: English
• Subjects: Acrocephalosyndactylia - surgery; Adolescent; Airway Obstruction - surgery; Biological and medical sciences; Cell physiology; Child; Child, Preschool; Cohort Studies; craniofacial; Craniofacial Dysostosis - surgery; Dental Occlusion; Dentistry; distraction osteogenesis; Follow-Up Studies; Forehead - surgery; Fundamental and applied biological sciences. Psychology; Humans; Infant; Le Fort; Malocclusion - surgery; Maxilla - surgery; Medical sciences; Mineralization, calcification; Molecular and cellular biology; monobloc; Nasal Bone - surgery; obstructive sleep apnea; Open Bite - surgery; Orbit - surgery; Orthodontics, Corrective; orthognathic; Orthognathic Surgical Procedures - methods; Osteogenesis, Distraction - instrumentation; Osteogenesis, Distraction - methods; Osteotomy, Le Fort - classification; Otorhinolaryngology. Stomatology; Patient Care Planning; Retrospective Studies; Skeleton and joints; Sleep Apnea, Obstructive - surgery; Surgery; Vertebrates: osteoarticular system, musculoskeletal system; Young Adult; Zygoma - surgery
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1016/j.ijom.2011.02.014

Abstract Severe midface hypoplasia in patients with various craniofacial anomalies can be corrected with Le Fort III or monobloc advancement. Often additional corrective orthognathic surgery is indicated to achieve Class I occlusion and a normal inter-jaw relationship. This study evaluated the incidence of, and the surgical indications for, secondary orthognathic surgery following Le Fort III/monobloc advancement. The total study group consisted of 41 patients: 36 patients with Le Fort III advancement and 5 patients with monobloc advancement. Seven patients underwent additional orthognathic surgery. Of the resulting 18 non-operated patients older than 18 years at the end of follow-up, Class I occlusion was observed in 11 patients. In the remaining patients malocclusions were dentally compensated with orthodontic treatment. None of the patients was scheduled for additional orthognathic surgery due to the absence of functional complaints and/or resistance to additional surgery. Le Fort III and monobloc advancement aim to correct skeletal deformities on the level of zygoma, orbits, nasal area and forehead, but Class I occlusion is frequently not achieved. Additional orthognathic surgery is often indicated in patients undergoing Le Fort III or monobloc advancement. Naso-endoscopic analysis of the upper airway and the outcomes of sleep studies may influence the orthognathic treatment plan.