Apples and oranges-midface hypoplasia and the Le Fort I osteotomy in cleft lip and palate patients: a classification scheme and treatment protocol.

OBJECTIVE: To present a classification and treatment protocol for cleft lip and palate patients with midface hypoplasia.

DESIGN: Retrospective case series.

SETTING: Craniofacial center.

PATIENTS: The study included 133 patients with cleft lip and palate and maxillary hypoplasia treated with Le Fort I osteotomy between January 2000 and July 2006.

INTERVENTIONS: Modified Le Fort I osteotomy. Patients were divided into three groups based on the number of free-standing bony maxillary segments, and treatment was tailored to their deformity.

MAIN OUTCOME MEASURES: Complications and long-term relapse rates.

RESULTS: The 133 patients underwent 142 operations with mean follow-up of 27 months. Mean horizontal advancement was 7.1 +/- 1.9 mm, 6.5 +/- 1.3 mm, 6.4 +/- 1.6 mm, and 6.5 +/- 1.3 mm for groups I, II, IIIA, and IIIB, respectively. Complications consisted of nine bony relapses, three hematomas, and two transitory neurosensory losses. Analysis of variance using number of maxillary pieces as the independent variable and millimeters of advancement as the dependent variable demonstrated no difference in the amounts that the groups were advanced (p = .23). Relapse rates for groups I, II, IIIA, and IIIB were 2/62 (3.2%), 5/53 (9.4%), 2/14 (14.3%), and 0/4 (0.0%), respectively. Analysis of variance did not demonstrate a statistical difference in relapse rates based on number of maxillary pieces.

CONCLUSIONS: Cleft lip and palate patients can be classified into three groups based on the number of maxillary segments. Our classification system defines the differences among this diverse group of patients and also facilitates unique treatment of each group.