Bone-on-Bone Telescopic Fixation With Step-Plate Stabilization: A Novel Approach for Enhanced Stability in LeFort I Maxillary Advancement for Cleft-Related Hypoplasia.

INTRODUCTION

Patients with cleft lip and palate (CLP) frequently require secondary LeFort I maxillary advancement due to severe scar-induced relapse with conventional techniques. This study introduced and evaluated bone-on-bone telescopic fixation with step-plate stabilization as a geometry-dependent solution to improve long-term stability. The aim of this study was to assess the skeletal stability, relapse rates, esthetic outcomes, and complications of the novel bone-on-bone telescopic LeFort I advancement technique in cleft maxillary hypoplasia.

MATERIALS AND

METHODS

A retrospective analysis of 90 consecutive non-syndromic CLP patients (52 females, 38 males; mean age 21.3 ± 3.8 years) who underwent LeFort I advancement using telescopic bone overlap and custom step-plate fixation between 2021 and 2022 was conducted. The minimum follow-up duration was 12 months. Horizontal and vertical stability was measured cephalometrically preoperatively (T0), immediately postoperatively (T1), and at ≥12-month (T2) intervals. A relapse >2 mm was considered clinically significant.

RESULTS

The mean horizontal advancement was substantial and highly significant (p < .001). At T2, relapse occurred in only 18 patients (20%); 14 patients (15%) showed <2 mm horizontal relapse, and only four patients (5%) showed >2 mm horizontal relapse. The vertical position remained stable (p = 1.0). The maxillary position and maxillomandibular relationship improved significantly and were largely maintained (p < .001). Facial aesthetic scores (FAS) increased from 4.5 ± 1.05 to 7.4 ± 0.94 (p < .001; Cohen's d = 3.68). The incidence of complications was low (nerve disturbance, 7%; infection, 5%; reoperation, 6%). Bone grafting was required in 18 patients (20%). No significant correlation was found between the magnitude of advancement and relapse (r = -0.36, p = 0.121).

CONCLUSION

The bone-on-bone telescopic technique with step-plate fixation provided superior skeletal stability, minimal clinically relevant relapse, excellent esthetic improvement, and a favorable safety profile, establishing it as a reliable and minimally invasive option for the definitive correction of cleft maxillary hypoplasia.