Comparison of the postoperative stability after repositioning of the maxilla with le fort i osteotomy using 4 versus 2 plate fixation

Restoring facial esthetics and occlusion while maintaining long term stability are the goals of orthognathic surgery. Conventionally, most of the oral and maxillofacial surgeons prefer to apply titanium miniplates in both the anterior aperture piriformis and the zygomaticomaxillary buttress area to achieve fixation of the maxilla. The purpose of this study was to compare the postoperative stability of the Le Fort I osteotomy using 4 plate fixation versus 2 plate alone. This study involved thirty nine patients with maxillary retrognathia and mandibular prognathia who underwent one piece Le Fort I osteotomy with bilateral sagital split ramus osteotomy. The stabilization of the repositioned maxilla was achieved with 1.5 mm titanium miniplates and screws. In group I, 4 miniplates placed at the apertura piriformis region and at the zygomaticomaxillary buttress whereas in group II, fixation was achieved with 2 miniplates at the piriform apertura bilaterally with no zygomaticomaxillary buttress fixation. Lateral cephalometric radiographs which were taken preoperatively, one week after surgery and late postoperatively were used to statistically analyze the stabilization of the skeletal movement. A significance level of 0.05 was predetermined. Statistically significant immediate postsurgical changes were found in both groups compared to presurgical cephalometric measurements. In late postoperative cephalometric measurements all landmarks in the horizontal and vertical plane showed statistically significant skeletal stability in 4-plate and 2-plate group. There was no significant difference between group I and II. The results of this study conclude that the postoperative stability of the 2-plate anterior fixation alone in the one piece Le Fort I ostetomy was similar and predictable, compared to conventional 4-plate internal fixation.