Three-Dimensional Segmental Stability of Multi-Piece Le Fort I Osteotomies vs. Single-Piece Maxillary Advancements in Cleft Lip and Palate Patients

Abstract

Background and Objective: Cleft lip and palate (CLP) patients frequently develop mid-facial hypoplasia necessitating orthognathic surgical intervention. The optimal approach—multi-piece Le Fort I osteotomy (MP-LFI) versus single-piece maxillary advancement (SP-MA)—remains contested, particularly regarding three-dimensional (3D) skeletal stability. This study prospectively compared 3D segmental stability, occlusal outcomes, and patient-reported quality of life at 24 months between the two techniques.

Methods: A prospective cohort study enrolled 100 skeletally mature CLP patients (52 MP-LFI; 48 SP-MA) at a tertiary craniofacial centre between January 2022 and December 2023. Cone-beam computed tomography (CBCT) with 3D cephalometric analysis was performed preoperatively, and at 1, 3, 6, 12, and 24 months postoperatively. Primary outcomes included 3D skeletal relapse vectors across the anteroposterior (X), vertical (Y), and transverse (Z) axes. Secondary outcomes comprised occlusal stability indices, patient-reported outcomes (PROs) using a 100-mm Visual Analogue Scale, and complication rates.

Results: At 24 months, the MP-LFI group demonstrated significantly lower total 3D relapse (3.1 ± 1.0 mm vs. 6.2 ± 1.7 mm; p < 0.001) and superior retention of planned movement (65.1% vs. 38.4%; p < 0.001). Stable occlusal outcomes (≤2 mm relapse) were achieved in 74.0% of MP-LFI patients versus 52.1% of SP-MA patients (p = 0.023). Quality of life scores were significantly higher in the MP-LFI cohort across all domains (p < 0.05). Complication rates were lower in the MP-LFI group (11.5% vs. 18.8%).

Conclusion: Multi-piece Le Fort I osteotomy provides superior three-dimensional skeletal stability over single-piece maxillary advancement in CLP patients at 24-month follow-up. The MP-LFI technique should be considered the approach of choice in patients with moderate-to-severe maxillary hypoplasia, transverse discrepancies, and arch constriction.