A COMPARATIVE STUDY OF SOFT TISSUE CHANGES OF MIDFACE FOLLOWING CONVENTIONAL LEFORT I OSTEOTOMY VERSUS DISTRACTION OSTEOGENESIS IN CLEFT PATIENTS

Abstract

The objective of this study was to compare the soft tissue thickness and anterior soft-tissue to hard tissue movement ratios in patients with unilateral and bilateral cleft lip and/or palate (UCLP and BCLP) following maxillary distraction osteogenesis (DO) using internal distractor device and Conventional maxillary advancement at Lefort I osteotomy (CO) using lateral cephalograms. This retrospective study was conducted on 22 patients with UCLP or BCLP who underwent either maxillary distraction osteogenesis (Group 1) or Lefort I maxillary advancement (Group 2) with 5-10 mm in maxillary advancement. The lateral cephalograms were taken before surgery at (T0) and after a minimum interval of six months (T1) and 1 year (T2) of surgery. Significant differences were not found between the DO and CO patients in soft tissue thickness at 6 months and 1 year. A statistical significance of sagittal advancement and downgrafting of soft tissue was not observed between the two groups at 6 months and 1 year. There were better correlations of hard and soft tissue changes with maxillary advancement. There were much more consistent hard to soft tissue ratios in maxillary advancement with DO than with CO. In conclusion, this study found no statistically significant differences in soft tissue thickness, sagittal advancement, or vertical downgrafting between distraction osteogenesis (DO) and conventional Le Fort I osteotomy (CO) in cleft patients at 6 months and 1 year postoperatively. Both techniques produced comparable soft tissue changes of the upper lip and nose, with soft tissue following hard tissue movement in both groups. However, DO demonstrated more consistent hard-to-soft tissue ratios in maxillary advancement than CO, suggesting a more predictable soft tissue response despite equivalent overall outcomes.

Keywords: Distraction Osteogenesis, Lefort 1 Osteotomy, Clefts, Maxillary Hypoplasia