Maxillary advancement in patients with severe maxillary hypoplasia: role of adjuvant stabilization techniques and materials.

Background: Maxillary advancement in patients with orofacial clefts or craniofacial syndromes can be technically challenging. We present our experience with the use of adjunctive stabilization materials and techniques in patients undergoing single-stage maxillary advancements of more than 6.0 mm.

Methods: A retrospective review was performed of 25 patients who underwent maxillary advancements of more than 6 mm with the use of specially manufactured rigid fixation plates, allograft, tongue-and-groove locking osteotomies, and bone morphogenic protein. No patients had intermaxillary fixation or postoperative external stabilization. There were 19 patients with orofacial clefts and 6 with a craniofacial syndrome, 13 male and 12 female patients, aged from 14 to 60 years with a mean age of 19 years. Six cases represented secondary operations. The maxilla was advanced at a range of 6.0 to 17.0 mm, mean of 9 mm. All patients were followed up by the same orthodontist preoperatively and postoperatively. Patient charts were reviewed for complications, relapse, malunion, and nonunion.

Results: There was 1 complication requiring embolization for bleeding. Three patients (12%) developed velopharyngeal incompetence postoperatively. There was no evidence of relapse, malunion, or nonunion. No patients required a second advancement.

Conclusions: The combination of specialized rigid fixation plates, allograft, tongue-and-groove locking osteotomies, and bone morphogenic protein was found to be safe and effective in preventing significant surgical relapse even after significant maxillary advancements.