Minimally invasive versus standard approach in LeFort 1 osteotomy in patients with history of cleft lip and palate - 16/05/18
, J. Bourlet a, f, N. Sigaux a, R.H. Khonsari b, c, d, J. Chauvel Picard a, A. Gleizal a, e, fBienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
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 1.17mm (vs. 1.29 and 1.48mm 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.
Le texte complet de cet article est disponible en PDF.Keywords : Cleft palate, Cleft lip, Orthognathic surgery, Le Fort osteotomy, Meta-analysis
Plan
Vol 119 - N° 3
P. 187-191 - juin 2018 Retour au numéro
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