A Modified Minimally Invasive Approach Towards Le Fort I Osteotomy: a Prospective Study

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT02660216

Acronym

MILF-I

Enrollment

Registered

2016-01-21

Start date

2014-11-30

Completion date

2019-12-31

Last updated

2021-01-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Jaw Abnormalities

Keywords

minimally invasive, le fort I osteotomy, 3D virtual treatment planning, accuracy

Brief summary

Nowadays, maxillary Le Fort I osteotomy is a safe and routinely performed procedure. The conventional approach is characterized by a vestibular incision extending from molar-to-molar, associated with a pterygomaxillary disjunction performed with a curved chisel. Adequate mobilization of the maxilla during Le Fort I osteotomy requires an effective separation of the maxillary tuberosity from the pterygoid plates of the sphenoid bone. However, as initially described by Precious (1991) and later by Hernandez-Alfaro (2013), a true pterygomaxillary osteotomy is not necessary to achieve successful disjunction. Furthermore, Hernandez-Alfaro combined his technique of pterygomaxillary disjunction, the so-called Twist technique, to a minimally invasive protocol, performing the complete Le Fort I osteotomy through a 20 to 30 mm long horizontal vestibular incision. Although promising, the technique remains highly sensitive from a technical standpoint, and its true accuracy has not been comprehensively evaluated. The purpose of this study is to present and validate a minimally invasive approach towards Le Fort I osteotomy, using a modified pterygomaxillary (PTM) disjunction technique. The primary outcome is to evaluate the accuracy of the technique using rigid voxel-based registration of the 3D virtual treatment planning and the 4 weeks postoperative CBCT images. Secondary outcomes include the surgical time necessary to complete the procedure and the presence of intraoperative and early postoperative complications.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Healthy volunteers

Inclusion criteria

* Patients of all ages * Patients of all genders * A Le Fort I osteotomy is planned, as part of a bimaxillary orthognathic procedure * The surgery is planned with 3D Virtual Treatment Planning (Maxilim v. 2.3.0.3.0.) * The planning is transferred with 3D CAD/CAM tooth-borne splint and vertical internal bony reference landmarks * The maxilla is repositioned first during the surgery (maxilla first sequence)

Exclusion criteria

* Patients not eligible according to abovementioned criteria * Simultaneous extraction of impacted teeth 18 and/or 28 * Previous maxillary orthognathic surgery * Previous Surgical Assisted Rapid Palatal Expansion (SARPE) * Syndromic condition, including cleft lip and palate * Segmental Le Fort I osteotomy * Adjuvant Zygomatic osteotomy * Maxillary impaction higher than 3 mm * Maxillary advancement greater than 5 mm

Design outcomes

Primary

Measure	Time frame
accuracy of the minimally invasive approach in comparison to conventional approaches, based on 3D virtual CBCT superimposition of planning CBCT and postoperative CBCT	at 4 weeks postoperative

Secondary

Measure	Time frame
Surgical time necessary to complete the procedure	perioperative
Intraoperative and early postoperative complications	within 4 weeks postoperative

Countries

Belgium

Outcome results