Minimally invasive versus standard approach in LeFort 1 osteotomy in patients with history of cleft lip and palate

Objective: Compare literature-reported efficiency and complications of the standard maxillary advancement surgery with those of a minimally invasive mucosal approach in patients with CL/P requiring Le Fort 1 osteotomy. Design: Meta-analysis vs. retrospective analysis of 18 consecutive cases. Setting: Department of maxillofacial surgery at a tertiary-level public general hospital. Participants: The meta-analysis encompassed Medline, Embase and Cochrane, years 1990 to 2014, inclusive. The local series concerned all squeletally mature adolescents with non-syndromic CL/P who underwent orthognathic surgery between 30 April 2004 and 27 January 2012. Interventions: Minimally invasive approach and perioperative orthodontics including intermaxillary fixation for 3 months after surgery. Main outcome measure(s): Assessment of complications. Standard lateral cephalograms were taken before surgery, then < 1 week and 12 months after surgery. Delaire's cephalometric analysis was performed and the position of the maxilla was recorded. Results: There were no significant differences between the literature and our series regarding sex and type of deformity (P = 0.634 and 0.779, respectively). The mean horizontal and vertical relapse rates were 0.61 and 1.17 mm (vs. 1.29 and 1.48 mm in the meta-analysis) and the overall complication rate was 22.2% (vs. 12.76% but P= 0.271). There was a significant difference regarding the palatal fistula rate (0 here vs. 21.43% in meta-analysis, P= 0.028). Conclusions: The minimally invasive approach showed trends toward less relapse and less complications than conventional approaches. This technique seems adapted to the management of patients with CL/P sequelae. Other benefiting groups are underway. (C) 2018 Elsevier Masson SAS. All rights reserved.