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89th Annual Meeting Abstracts

Management of Early LeFort III Patients after Skeletal Maturity
Edward J. Caterson, M.D., Ph.D., Pradip Shetype, DMD, Joseph G. McCarthy, M.D., Barry H. Grayson, DDS.
New York University, New York, NY, USA.

Purpose: The constellation of severe brachycephaly with midface hypoplasia is common to patients with Crouzon, Pfieiffer and Apert syndromes. This midface hypoplasia is characterized by nasomaxillary and zygomatic hypoplasia, upper dental arch retrusion, and anterior crossbite. Traditional Le Fort III osteotomy with midface advancement, bone grafting, and rigid fixation often can improve obstructive sleep apnea, corneal exposure, dental relations, and dysmorphic facies. Often the obstructive sleep apnea, or corneal exposure necessitates the Le Fort III intervention in the growing child. As, the trend towards early intervention increases there is little data available to predict the type and frequency of secondary surgery required after skeletal maturity. The classic Le Fort III has been reported stable out to 10 years. However longitudinal cephalometric studies have demonstrated that in patients with syndromic craniosynostosis, midface growth in the forward direction is severely diminished despite intervention. In addition to the anticipated needs for orthognathic correction, it is unknown if early Le Fort III prevents the need for subsequent midface advancement at skeletal maturity.
Methods: We identified twenty-four syndromic patients who had undergone an early Le Fort III (mean age 5 years) who have been followed through skeletal maturity (mean age 19.5 years). Of these 24 patients, 10 have Crouzon, 9 have Aperts, and 5 have Pfeiffers. Upon reaching skeletal maturity, all patients required a secondary surgical procedure to correct occlusion: an isolated orthognathic group or those requiring repeat midface advancement. Cephalometric data was collected at appropriate clinical time points and traced at 6 months and one year post early Le Fort III, as well as after the final surgery post skeletal maturity.
Results: 100 % of the identified patient population underwent further surgical procedures after skeletal maturity. 50 % of patients needed only a final orthognathic procedure to correct abnormal dental relationships. In this group, the early Le Fort III was sufficient enough to obviate the need for repeat midface advancement. In addition to an orthognathic procedure the remaining 50 % of patients required a subsequent Le Fort III or Le Fort II advancement.
Conclusions: Achieving definitive early correction of midface hypoplasia with a single surgery is a challenging task. This is the first reported series of syndromic patients who have undergone early Le Fort III advancement and reached skeletal maturity. The data demonstrate that at least half of the patients who undergo an early Le Fort III will need an additional procedure to correct a persistent midface deformity after skeletal maturity. The need for secondary advancement procedure is not related to relapse but instead is due to intrinsic growth disturbances in the previously advanced segment.


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