Inferior positioning of the maxilla by a Le Fort I osteotomy: a review of 25 patients with vertical maxillary deficiency

In 25 patients with vertical maxillary deficiency, selected from a group of 410 Le Fort I osteotomies, the anterior part of the maxilla was repositioned inferiorly. Four groups could be distinguished. A group (n=6) with downgrafting of the maxilla alone, fixed with wire osteosynthesis, a group (n=6) treated with Le Fort I and sagittal split osteotomy with a wire-fixed maxilla, a group (n=8) with a Le Fort I and vertical ramus osteotomy where the maxilla was fixed with wire and a group (n=5) treated by Le Fort I and vertical ramus osteotomy in which the maxilla had been fixed with miniplate osteosynthesis. In the group of single maxilla repositioning and in the bimaxillary group with a plate-fixed maxilla, the range of relapse was −0.3 mm to +1.0 mm (mean +0.4 mm) and 0 mm to +1.0 mm (mean +0.5 mm) respectively, which was not correlated to the distance of inferior repositioning. The bimaxillary cases, in which the maxilla had wire osteosynthesis, showed postoperative relapse ranging from −1.4 mm to +3.4 mm (mean +1.3 mm) (sagittal split osteotomy) and −1.1 mm to +3.7 mm (mean +1.2 mm) (vertical ramus osteotomy). In these cases the outcome of surgical intervention appeared completely unpredictable. If these figures are presented as percentages as is done in the literature in the majority of publications, a misleading impression appears. Likewise information about operation technique, fixation methods and linear measurements of movement and relapse (instead of percentages) are essential in comparing different studies.