THE 3-DIMENSIONAL STABILITY OF MAXILLARY OSTEOTOMIES IN CLEFT-PALATE PATIENTS WITH RESIDUAL ALVEOLAR CLEFTS

Objectives-To evaluate the stability of maxillary osteotomies in cleft palate patients using miniplate fixation. Design-A prospective clinic al study. Subjects-46 consecutive cleft palate patients with residual alveolar clefts and maxillary hypoplasia in one or more dimensions. Th ese patients underwent standardised maxillary osteotomies and simultan eous bone grafting of the alveolar cleft over 44 months during 1988-19 92. Titanium mini-plate fixation was used for the maxilla in all patie nts. Follow-up ranged from 6 to 51 months with a mean of 28 months. Ma in outcome measures-The 3-dimensional stability of maxillary osteotomi es in cleft palate patients in the long term. Results-In the unilatera l clefts, relapse in the horizontal plane was 22% and in the vertical plane 22.5%; in bilateral clefts, the relapse was 17.5% and 7% respect ively, with no statistically significant difference between the two gr oups. Longitudinal analysis of the repositioned maxilla over a 3-year period showed that most of the relapse occured in the first 6 months a nd stabilised at 2 years postoperatively. Relapse in the transverse pl ane, based on analysis of the study models of 26 cases, ranged from 13 .4% to 33.6%. A clockwise rotational relapse of the maxilla was noted in bilateral cases. Postoperative orthodontics compensated for the hor izontal relapse by increasing incisor proclination to maintain positiv e overjet. There was no significant difference between the relapse of bimaxillary cases and that of maxillary osteotomies alone. Conclusion- The long-term 3-dimensional surgical stability, using miniplate fixati on, has decreased the relapse of cleft maxillary osteotomies with simu ltaneous alveolar bone grafting to a level comparable to that of maxil lary osteotomies in non-cleft patients.