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Quantitative Assessment of Maxillary Bone Density and Thickness in Cleft Versus Non-Cleft Patients Undergoing Le Fort I Osteotomy
Thomas Ren
1, Yuri Zhang
1, Charbel Saad
1, Richard Redett
1, Robin Yang
1, Pasha Shakoori
1
1. Plastic Surgery, Johhs Hopkins School of Medicine, Hopewell Junction, NY, United States.
Introduction: The nasomaxillary buttress (NMB) and pterygomaxillary junction (PMJ) serve as key osteotomy points during Le Fort I advancement. In patients with cleft lip and palate (CLP), anatomical variation in these regions may influence bone quality and surgical outcomes. We aimed to compare bone density and thickness in patients with and without CLP using preoperative computer tomography (CT) maxillofacial scans.
Methods: Preoperative CT scans were reviewed for 24 patients undergoing Le Fort I osteotomy, 12 with diagnosed CLP and 12 non-cleft controls. Bone thickness (mm) and density (HU) were measured at the NMB, along with width (mm) and height (mm) at the PMJ using standardized multiplanar and 3D reconstructions. Maxillary height, width, and length were also recorded.
Results: The average age at scan was 17.6±1.1 years (cleft) vs. 18.6±1.0 years (control). Patients with CLP had significantly higher bone density in the NMB (725.5 vs. 596.1 HU;
p<0.05). PMJ width was significantly less in the cleft cohort (4.2 vs. 5.4 mm;
p<0.05), while NMB thickness trended less in the cleft cohort (2.8 vs. 3.4 mm;
p=0.07). Patients with CLP had shorter palatal length (34.1 vs. 48.5 mm;
p<0.001) and width (22.3 vs. 28.4 mm;
p<0.001). For additional analysis, all non-cleft patients and the non-cleft control sides of unilateral CLP patients were grouped into a single control category, while the cleft side of unilateral patients and all bilateral CLP patients were analyzed separately as the cleft category. Both the NMB and PMJ densities remained significantly elevated (740.7 vs. 616.9 HU;
p<0.001, 1078.4 vs. 1011.7;
p<0.05).
Conclusion: Patients with CLP exhibit increased bone density and decreased thickness at critical Le Fort I osteotomy sites compared to non-cleft controls. These findings suggest thinner maxillary bone may prompt compensatory mechanisms that favor the formation of denser, more scar-laden bone in mechanically stressed regions, requiring changes in osteotomy technique to mitigate complications during cleft orthognathic procedures.
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