Bony Stability and Soft Tissue Changes after Orthognathic Surgery on Patients with Cleft.

Shin, Heakyeong; Hsieh, Yuh Jia; Liao, Yu Fang; Lo, Lun Jou; Jo, Myoung Soo

doi:2012.13.1.4

Arch Craniofac Surg > Volume 13(1); 2012 > Article

Original Article

Archives of Craniofacial Surgery 2012;13(1):4-10.
DOI: https://doi.org/10.7181/acfs.2012.13.1.4

Bony Stability and Soft Tissue Changes after Orthognathic Surgery on Patients with Cleft.

Heakyeong Shin, Yuh Jia Hsieh, Yu Fang Liao, Lun Jou Lo, Myoung Soo Jo

¹Department of Plastic and Reconstructive Surgery, Dongguk University Gyeongju Hospital, Gyeongju, Korea.
²Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
³Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. lunjoulo@cgmh.org.tw
⁴Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Abstract

PURPOSE
The objective of this retrospective study was to assess the skeletal stability after orthognathic surgery for patients with cleft lip and palate. The soft tissue changes in relation to the skeletal movement were also evaluated. METHODS: Thirty one patients with cleft received orthognathic surgery by one surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Osseous and soft tissue landmarks were localized on lateral cephalograms taken at preoperative (T0), postoperative (T1), and after completion of orthodontic treatment (T2) stages. Surgical movement (T0-T1) and relapse (T1-T2) were measured and compared.
RESULTS
Mean anteroposterior horizontal advancement of maxilla at point A was 5.5 mm, and the mean horizontal relapse was 0.5 mm (9.1%). The degree of horizontal relapse was found to be correlated to the extent of maxillary advancement. Mean vertical lengthening of maxilla at point A was 3.2 mm, and the mean vertical relapse was 0.6 mm (18.8%). All cases had maxillary clockwise rotation with a mean of 4.4 degrees. The ratio for horizontal advancement of nasal tip/anterior nasal spine was 0.54/1, and the ratio of A' point/A point was 0.68/1 and 0.69/1 for the upper vermilion/upper incisor tip.
CONCLUSION
Satisfactory skeletal stability with an acceptable relapse rate was obtained from this study. High soft tissue to skeletal tissue ratios were obtained. Two-jaw surgery, clockwise rotation, rigid fixation, and alar cinch suture appeared to be the contributing factors for favorable results.

Keywords: Orthognathic surgery; Cleft lip and palate; LeFort I osteotomy