Lefort II distraction with zygomatic repositioning versus Lefort III distraction: A comparison of surgical outcomes and complications

Document Type

Article

Abstract

The aim of the study was to determine if the additional surgical complexity of Lefort II distraction with zygomatic repositioning (LF2ZR) results in increased complications compared to Lefort III distraction (LF3). A retrospective review was performed of all LF3 and LF2ZR advancements performed by the senior author over 15 years. Demographic, operative, postoperative, and cephalometric data were collected from initial procedure through greater than 1 year postoperatively. Univariate and multivariate analyses were performed to compare procedures. 19 LF2ZR and 39 LF3 in 53 patients met inclusion criteria. Diagnoses differed between procedures, with more Crouzon Syndrome in LF3 and more Apert Syndrome in LF2ZR. Complication rate was 7/19 for LF2ZR and 12/39 for LF3 with no severe morbidity or mortality, and no difference between procedures (p = 0.56). The types of complications encountered differed between procedures. LF2ZR had a significantly longer operative time (506 ± 18 vs. 358 ± 24 min, p<0.001). However, a greater number of LF2ZR patients underwent concomitant procedures (15/19 vs. 13/39, p<0.001). Multivariate analysis revealed that Apert Syndrome and reoperative midface advancement were the most significant predictors of increased blood loss. LF2ZR has an equivalent complication rate to LF3. Therefore, it is our treatment of choice for cases requiring differential sagittal and vertical distraction of the central midface.

Medical Subject Headings

Cephalometry; Craniofacial Dysostosis (surgery); Humans; Osteogenesis, Distraction (adverse effects); Osteotomy, Le Fort; Retrospective Studies; Treatment Outcome

Publication Date

10-1-2021

Publication Title

Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

E-ISSN

1878-4119

Volume

49

Issue

10

First Page

905

Last Page

913

PubMed ID

33965326

Digital Object Identifier (DOI)

10.1016/j.jcms.2021.03.003

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