Speech Outcome and Velopharyngeal Function in Cleft Palate: Comparison of Le Fort I Maxillary Osteotomy and Distraction Osteogenesis—Early Results

2007 ◽  
Vol 44 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Nattharee Chanchareonsook ◽  
Tara L. Whitehill ◽  
Nabil Samman
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Gap Size ◽  
Le Fort I Osteotomy ◽  
Chi Square ◽  
Le Fort ◽  
Le Fort I ◽  
Nasal Emission ◽  
Maxillary Distraction

Objective: To compare speech outcome and velopharyngeal (VP) status of subjects with repaired cleft palate who underwent either conventional Le Fort I osteotomy or maxillary distraction osteogenesis to correct maxillary hypoplasia. Design: Prospective randomized study with blind assessment of speech outcome and VP status. Subjects: Twenty-two subjects were randomized into conventional Le Fort I osteotomy and Le Fort I distraction groups. All were native Chinese (Cantonese) speakers. Method: Perceptual judgment of resonance and nasal emission, study of VP structures by nasoendoscopy, and instrumental measurement by nasometry. Assessments were performed preoperatively and at 3 months postoperatively. Main Outcome Measures: Assessment of VP closure, perceptual rating of hypernasality and nasal emission, nasalance, and amount of maxillary advancement. Results: There was no statistical difference in any of the outcome measures between the 10 subjects with conventional Le Fort I osteotomy and the 12 subjects with maxillary distraction: hypernasality (chi-square = 3.850, p = 0.221), nasal emission (chi-square = 0.687, p = 0.774), VP gap size (chi-square = 1.527, p = 0.635, and nasalance (t = −0.145, p = 0.886). There was no correlation between amount of maxillary advancement and any of the outcome measures (p = .05 for all). Changes in VP gap size and resonance are described. Conclusion: Results need to be interpreted with caution because of the small sample size and early follow-up. However, this study utilized an assessment protocol involving a variety of outcome measures and careful consideration of reliability factors, which can be a model for further and follow-up studies.

Frequency of Le Fort I Osteotomy after Repaired Cleft Lip and Palate or Cleft Palate

2007 ◽  
Vol 44 (4) ◽  
pp. 396-401 ◽  
Author(s):  
Phoebe M. Good ◽  
John B. Mulliken ◽  
Bonnie L. Padwa
Keyword(s):  
Cohort Study ◽  
Cleft Palate ◽  
Retrospective Cohort ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Le Fort I Osteotomy ◽  
Chi Square ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Le Fort I

Objective: Diminished maxillary growth is a consequence of labiopalatal repair, and many patients with cleft lip and palate require Le Fort I advancement. The goal of this study was to determine the frequency of maxillary hypoplasia as measured by need for Le Fort I. Subjects: Retrospective cohort study of males born before 1987 and females before 1989. Records of 173 patients with cleft lip and palate and 34 with cleft palate were reviewed. Methods: Documented age, gender, cleft type, and need for Le Fort I. Pearson chi-square and Fischer's exact analyses were performed to evaluate the frequency of Le Fort I. Results: Of 217 patients with cleft lip and palate or cleft palate, 40 were syndromic; of the remaining 177 patients, 69 had cleft lip, 78 had cleft lip and palate, and 30 had cleft palate. Thirty-seven of 177 patients (20.9%) required Le Fort I, subcategorized by cleft type: 0/69 for cleft lip, 37/78 for cleft lip and palate, and 0/35 for cleft palate (p < .0001). Of the 37/78 (47.4%) cleft lip and palate patients, the frequency of Le Fort I correlated with severity: 5/22 unilateral incomplete cleft lip and palate; 16/33 unilateral complete cleft lip and palate; 1/2 bilateral incomplete cleft lip and palate; 2/4 bilateral asymmetric complete/incomplete cleft lip and palate; 13/17 bilateral complete cleft lip and palate (p < .05). Conclusion: Overall frequency of Le Fort I was 20.9% in patients with cleft lip and palate and cleft palate. Of those with cleft lip and palate, 47.7% required maxillary advancement, but none with isolated cleft lip or cleft palate required correction. Frequency of Le Fort I osteotomy correlated with the spectrum of severity of labiopalatal clefting.

Submucous Cleft Palate: A Grading System and Review of 40 Consecutive Submucous Cleft Palate Repairs

2004 ◽  
Vol 41 (2) ◽  
pp. 114-123 ◽  
Author(s):  
Brian C. Sommerlad ◽  
Christopher Fenn ◽  
Kim Harland ◽  
Debbie Sell ◽  
Malcolm J. Birch ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Outcome Measures ◽  
Consecutive Series ◽  
Gap Size ◽  
Velopharyngeal Closure ◽  
Submucous Cleft Palate ◽  
A Prospective Study ◽  
Nasal Emission ◽  
Outcome Of Surgery

Objective This study was designed to determine whether velar surgery was worthwhile for submucous cleft palate (SMCP) and evaluate whether results were dependent on the degree of the anatomical abnormality. Design A prospective study of a consecutive series of patients fulfilling the entry criteria, assessed blindly from records arranged randomly. Patients Fifty-eight patients diagnosed with SMCP and operated on by a single surgeon between June 1991 and April 1997 were reviewed. Forty patients fulfilled the entry criteria. Minimum follow-up was 6 years. Interventions Radical reconstruction of the soft palate musculature was performed by one surgeon using the operating microscope. A scoring system was devised for grading the anatomical severity of submucous cleft (SMCP score). Main Outcome Measures Postoperative hypernasality and nasal emission scores and the degrees of improvement were considered the primary outcome measures, and the degree of velopharyngeal closure was also assessed. Results There were highly significant improvements in hypernasality, nasal emission, and velopharyngeal closure. A preoperative gap size of more than 13 mm was associated with less satisfactory outcomes, but gap size was not predictive of improvement. Severity of the SMCP did not correlate with the degree of preoperative speech abnormality but was a significant predictor of outcome of surgery, with the less severe (total SMCP score of 0 to 3) having less satisfactory end results and lesser degrees of improvement. Patients with less abnormal muscle anatomy had lesser degrees of improvement. Conclusion Repair of the muscle abnormality in SMCP is recommended as the first line of treatment in most cases.

scholarly journals Three dimensional assessment of segmented Le Fort I osteotomy planning and follow-up: a validation study

2021 ◽  
pp. 103707
Author(s):  
Oliver da Costa Senior ◽  
Lukas Vaes ◽  
Delphine Mulier ◽  
Reinhilde Jacobs ◽  
Constantinus Politis ◽  
...  
Keyword(s):  
Validation Study ◽  
Three Dimensional ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Dimensional Assessment ◽  
Le Fort I

scholarly journals Correction of gummy smile by superior repositioning of maxilla in Bangladeshi people

2016 ◽  
pp. 1-5
Author(s):  
Abdullah Al Masud ◽  
Muhammad Shohag Shikder ◽  
Mohammad Tofazzal Hossan ◽  
Mohammad Mahfuzul Gani ◽  
Mohammad Wahidul Islam
Keyword(s):  
Orthodontic Treatment ◽  
Class Ii ◽  
Class I ◽  
Class Ii Malocclusion ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Le Fort I ◽  
Gummy Smile

Vertical maxillary excess is associated with gummy smile, incompetent lip,  bimaxillary proclination, Angle’s class-I or class-II malocclusion with or without retogenia. After proper evaluation preoperative orthodontic treatment was performed in every cases and superior repositioning of the maxilla by Le Fort-I osteotomy is presented. Three patients with maxillary excess associated with retrogenia or microgenia were treated with this technique in combination with genioplasty. The maxillary segment was repositioned a maximum of 7.0 mm superiorly at point A. The mandible autorotated anterosuperiorly to achieve sound occlusion. Point B moved 1.0–3.0 mm anteriorly and 5.0–8.0 mm superiorly. The pogonion moved 4.0 mm anteriorly in a case done without genioplasty and the pogonion moved maximum 8.0mm in case done in combination with genioplasty. All patients obtained sound occlusion and a good profile after the operation. Almost no skeletal relapse was observed during 3 years of postoperative follow-up. Amount of gingiva showing during smile was ranges from 5.0mm –7.0mm which was 0-2.0mm after superior repositioning of the maxilla. Ban J Orthod & Dentofac Orthop, April 2016; Vol-6 (1-2), P.1-5

scholarly journals Skeletal stability after maxillary step osteotomy compared with original Le Fort I osteotomy during one-year of follow-up

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kazuto Kurohara ◽  
Nobuyoshi Tomomatsu ◽  
Koichi Nakakuki ◽  
Naoya Arai ◽  
Tetsuya Yoda
Keyword(s):  
Le Fort I Osteotomy ◽  
Le Fort ◽  
One Year ◽  
Le Fort I ◽  
Skeletal Stability

Midfacial growth and dental arch relationships in bilateral cleft palate following secondary alveolar bone grafting and orthodontic intervention: Factors predicting a Le Fort I osteotomy at age 18

2018 ◽  
Vol 46 (10) ◽  
pp. 1764-1771
Author(s):  
Gerhard K.P. Bittermann ◽  
Adrianus P. de Ruiter ◽  
Arnold JN. Bittermann ◽  
Aebele B. Mink van de Molen ◽  
Robert JJ. van Es ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Bone Grafting ◽  
Alveolar Bone ◽  
Dental Arch ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Alveolar Bone Grafting ◽  
Le Fort I ◽  
Secondary Alveolar Bone Grafting
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