Cleft Lip and Palate and Other Syndromes – Part 3
Le Fort III distraction osteogenesis versus conventional Le Fort III osteotomy for the correction of syndromic midface hypoplasia: a systematic review
Humam Saltaji 1 , Mostafa Altalibi 2 , Michael P Major 3 , Muhammed H Al-Nuaimi 4 , Sawsan Tabbaa 5 , Paul W Major 6 , Carlos Flores-Mir
Abstract
Objective: There is ongoing debate regarding whether the Le Fort III procedure using distraction osteogenesis (LFIII-DO) reduces the risk of postoperative recurrence compared to conventional Le Fort III osteotomy (LFIII) in the correction of syndromic midface hypoplasia.
The objective of this study was to evaluate the short- and long-term stability of bone structures following midface advancement performed using conventional LFIII osteotomy versus LFIII-DO osteotomy in patients with syndromic midface hypoplasia.
Materials and Methods: We conducted a systematic review of published data. An electronic search was performed in 10 databases, covering the period from their inception through June 2012. The reference lists of relevant publications were also reviewed.
Studies were included if they were longitudinal clinical studies with a follow-up period of at least one year after surgery (LFIII group) or until the end of the consolidation phase (LFIII-DO group).
Study selection, assessment of risk of bias, and data extraction were performed in duplicate. Due to methodological and clinical heterogeneity among the studies, it was not possible to pool the results in a meta-analysis.
Results: A total of 57 articles met the initial search criteria, and 12 were selected for the final analysis.
Studies have shown an average midface advancement of:
8 to 12 mm in the LFIII group
9 to 16 mm in the LFIII-DO group
For the LFIII group, short-term horizontal follow-up showed a maximum recurrence rate of 8.7% to 11.9% in two studies, while one study reported a much higher rate of up to 50%.
For the LFIII-DO procedure, the short-term horizontal recurrence rate was 14.4% in one study, while other studies reported rates below 10%. Furthermore, three studies even demonstrated additional progression without recurrence.
Conclusions: Current data suggest that both conventional LFIII and LFIII-DO techniques effectively advance the midface complex in patients with syndromic midface hypoplasia, with good to excellent stability and a low recurrence rate.
However, the LFIII-DO technique appears to offer a more significant improvement, with a lower recurrence rate compared to the conventional LFIII technique.