Facial clefts, including cleft lip and palate, are among the most common congenital deformities, affecting approximately 1 in 700 live births worldwide. Individuals with facial clefts frequently exhibit midface hypoplasia, characterized by an underdeveloped and retruded maxilla1. This anatomical deficiency often leads to malocclusion, impaired speech, and difficulties with mastication. Maxillary advancement, most commonly achieved through Le Fort I osteotomy, is a vital surgical intervention aimed at correcting these functional and aesthetic impairments. The Le Fort I osteotomy is a horizontal maxillary advancement procedure used to correct midface deformities by allowing multidirectional movement of the dentition-bearing maxilla, including segmentation or expansion2. The technique is named after the horizontal fracture pattern identified by Rene LeFort in 1901.Initially, maxillary osteotomies were performed for better exposure during nasopharyngeal polyp removal. Wassmund first applied the LeFort I approach to dentofacial deformities in 1921 using orthopedic traction, while Auxhausen introduced intraoperative mobilization in 1934 to address open bite. Schuchardt later advanced the technique by separating the pterygomaxillary junction to allow anterior repositioning. Bell’s pivotal research established the biological foundation of the procedure, demonstrating revascularization capacity and osseous healing even when sacrificing the descending palatine arteries. Over time, the method has evolved with advancements such as hypotensive anesthesia, orthodontic collaboration, and virtual surgical planning3. Today, the LeFort I osteotomy is recognized as a reliable, safe, and predictable intervention in maxillofacial surgery. In patients with cleft lip and palate, this procedure is typically performed after a series of initial cleft repair surgeries that are designed to restore the basic anatomy and function of the affected structures. Le Fort I osteotomy (LF1) is the most commonly used surgical procedure to correct midfacial deformities such as maxillary retrusion, protrusion, and asymmetry. The osteotomy is performed horizontally from the piriform rim to the posterior maxilla, allowing the bone to be repositioned for improved facial profile and occlusion4. While LF1 significantly enhances masticatory function and facial aesthetics, it often leads to undesirable nasolabial changes, including widening of the alar base and nasal tip upturning, especially with anterior repositioning. Techniques like alar base cinch sutures, subspinal osteotomy, and nasal floor reduction are employed to mitigate these changes. Among them, the alar cinch suture controls alar widening, while subspinal LF1 aims to preserve nasal anatomy5,6. Despite these efforts, variations in nasal shape changes remain unpredictable, even with 3D simulations. Factors such as the degree of maxillary advancement and individual nasal cartilage anatomy also play a role. Outcomes may vary with the racial differences. 7-10. This case series examines the outcomes of maxillary advancement in 30 patients with facial clefts, focusing on both the functional improvements and the aesthetic results following surgery11,12. AIM To assess the outcomes of Le Fort I osteotomy with maxillary advancement in correcting maxillary hypoplasia and improving functional, and aesthetic outcomes in patients with a history of cleft lip and palate repair.

A prospective study was conducted from June 2023 to June 2025, involving a study population of 30 patients. All patients underwent maxillary advancement using the Le Fort I osteotomy technique. The inclusion criteria for the study were a documented history of cleft lip and palate repair during childhood, clinically and radiologically confirmed maxillary hypoplasia, and the presence of indications for surgical correction such as facial asymmetry and malocclusion. Patients were excluded from the study if they had an active infection or significant medical comorbidities that could contraindicate surgery.

Table 1: Gender Distribution GENDER NUMBER MALE 6 FEMALE 24 The study population consisted of 30 patients, with 6 male (20%) and 24 females (80%). Table 2: Age distribution Age Number 13-15 years 5 16-18 years 24 19-20 years 1 >20 Years 0 The age distribution of the study population was the majority of patients were in the 16–18 years age group (24 cases), followed by 5 cases in the 13–15 years group and 1 case in the 19–20 years group. No patients were observed above 20 years of age. Table 3: Maxillary advancement Range Range 9 Patient 6mm 6 Patient 5.5mm 8 Patient 7mm 4 Patient 6mm 3 Patient 8mm The amount of maxillary advancement ranged from 5 mm to 7 mm, with 9 Patients at 6 mm, 6 patients at 5.5 mm, 8 patients at 7 mm, 4 Patients at 6 mm, and 3 Patient at 8 mm. Table 4: Complications during procedure Complications Number Pain 27 Facial Edema 3 Difficulty in breathing 0 Relapse 0 Postoperative complications included pain was the most common complication seen in 27 patients, followed by facial edema in 3 patients, while no cases of breathing difficulty or relapse were reported.

Maxillary hypoplasia is a common and challenging sequela in patients with a history of cleft lip and palate, characterized by midface retrusion, facial asymmetry, and malocclusion. Le Fort I osteotomy with maxillary advancement is the gold standard surgical approach for correcting maxillary hypoplasia in cleft patients. The surgical technique involves a horizontal osteotomy at the Le Fort I level, mobilizing the maxillary segment as a single unit. Rigid fixation using L-shaped titanium plates and screws ensures the stability of the advanced maxilla, minimizing the risk of postoperative relapse. In both cases, the planned maxillary advancement was guided by detailed preoperative cephalometric analysis and dental model along with intraoperative assessment, ensuring precise correction of the midface deficiency. The outcomes in all the patients were favorable, with significant improvements in facial profile, correction of malocclusion, and patient satisfaction. Postoperative assessments showed stable maxillary positioning with no signs of relapse or complications such as infection, malunion, or skeletal instability. All the patients reported improved mastication, speech function, and self-confidence, highlighting the positive impact of maxillary advancement on functional and psychosocial aspects. In this study, the gender distribution of the participants showed that 6 patient (20%) was male, while the remaining 24 patients (80%) were female. This indicates a higher representation of female patients within the study population. The gender ratio reflect the sample size or demographic characteristics of the population studied. Females constituted the majority of the cases included in this research. Similarly, Garg S, Kaur S13. The total number of patients in the study was 25, with a majority being female. Specifically, there were 3 male patients and 22 female patients. This distribution indicates that females comprised the larger proportion of the Study population. The age distribution of the study population was as follows: 5 patients were between 13 and 15 years old. 24 patients were between 16 and 18 years old and 1 patients were between 19 and 20 years old. There were no patient older than 20 years. In our study the maxillary advancement in 9 patients was 6 mm. 6 patients underwent an advancement of 5.5 mm. 8 patients had the greatest advancement of 7 mm. 4 patients received a 6 mm advancement. 3 patients had the advancement of 8 mm. The mean maxillary advancement calculated from these values is 6.4 mm, indicating that, on average, patients in our study underwent approximately 6.4 mm of maxillary advancement. Similarly, in a study done by Mistry, Taher Abbas14; the mean advancement ranged from 6.59 mm to 16.5 mm for DOM, 6–14.28 mm for AMD and 5.17– 7.2 mm for CLO. Relapse was 8.24%–45% for DOM, 4.6%–7% for AMD and 21.63%–63% for CLO. In our study, the most common complication observed was pain, reported in 27 patients. Facial edema was noted in 3 patients, while no cases of difficulty in breathing or relapse were observed. Overall, complications were minimal and manageable. Shehab Al-Din et al.15 in their study on 20 patients for buccal gingivae sensation following Le Fort I osteotomy found that fine touch sensation was present in 19 patients at 6 months while 85 % of patients regained some pin prick sensation at 6 months in the buccal mucosa. Kramer et al.16 conducted a prospective study on intra and perioperative complications of the Le Fort I osteotomy in a large series of patients and found the overall complication rate to be 6.4 %.

Le Fort I osteotomy with maxillary advancement is a highly effective surgical intervention for correcting maxillary hypoplasia in patients with a history of cleft lip and palate. The cases presented demonstrate significant improvements in facial aesthetics, occlusion, and quality of life, highlighting the value of this approach in managing craniofacial deformities. The procedure not only addresses the anatomical and functional deficits but also profoundly enhances patients’ quality of life by restoring facial aesthetics and self-confidence.

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