LE FORT I OSTEOTOMY WITH MASTOID BONE INTERPOSITIONAL GRAFT
Le Fort I osteotomy permits a three dimensional reposition of the maxilla. Greater movements (< 5 mm) are associated with higher rates of complications, including malunion and relapse. The use of interpositional grafts is considered the standard procedure in these cases. However, the type of the material to be interposed is still controversial.
The objective of this study was to evaluate patients that underwent Le Fort I osteotomy with anterior reposition greater than 5 mm, which mastoid bone autograft was used as interpositional graft.
We studied 15 patients that underwent Le Fort I osteotomy with mastoid bone interpositional graft. Data collected were: dentofacial deformity, surgical technique, patient satisfaction, and complications.
Age ranged from 16 to 59 years (mean 38.1 years); 6 female and 9 male. Regarding dentofacial deformity, 12 were Class III and 3 were Class I (with obstructive sleep apnea). All patients underwent maxillary osteotomy Le Fort I with anterior reposition greater than 5 mm (mean 7,2 mm), of which 5 underwent concomitant mandibular sagittal split (3 advancement and 2 setback). Chin osteotomy was performed in 8 patients.
From the aesthetic point of view, all patients but one were satisfied (chin asymmetry). With regard to complications, 2 patients presented paresthesia in the region of the inferior alveolar 6 months after surgery; 1 patient developed seroma in the region of the mastoid bone harvesting; 4 patients developed hemotympanum that resolved in no more than 30 days. No patient presented signs of malunion or relapse that needed reoperation.
Mastoid bone presented as a good site for interpositional graft for Le Fort I osteotomy. It has the advantage of virtually no donor site morbidity. No signs of relapse and malunion were present in this study; however, detailed cephalometric studies should be performed to further evaluate this graft