In a two-piece LeFort osteotomy for maxillary transverse discrepancy, is a palatal strap or a strut more stable in the immediate post-operative recovery period?

Palatal Strap vs. Strut for Stability in Two-Piece LeFort Osteotomy

A palatal strut is more stable than a palatal strap during immediate post-operative recovery after two-piece LeFort osteotomy for maxillary transverse discrepancy correction. 1

Anatomical Considerations and Stability Factors

Palatal Strut Benefits

• Provides direct structural support between medial crura for realignment and stabilization
• Allows for resection of deviated septal portions without risking columellar retraction
• Creates a rigid framework that maintains the corrected position of maxillary segments 1
• Helps prevent transverse relapse, which is a significant concern in segmental maxillary osteotomies

Transverse Stability Challenges

• Segmental maxillary osteotomies show high relapse rates in the dentoalveolar area (60-68%) without proper stabilization 2
• While skeletal base expansion shows only 9% relapse, the dental arch demonstrates much higher relapse potential 2
• Two-piece maxillary procedures have shown approximately 60% relapse of surgically expanded transverse width over long-term follow-up 3

Surgical Technique Considerations

Optimal Strut Placement

• A strut placed between the medial crura provides superior support and realignment compared to a strap 1
• The strut should be positioned to maintain the corrected transverse position while allowing for proper healing of the osteotomy sites
• This technique is particularly important when significant expansion is required

Alternative Stabilization Methods

• Fixation of the palatal vault with resorbable plates has shown potential to improve transverse stability 2
• In cases requiring major expansion, additional stabilization methods should be considered alongside the strut

Post-Operative Management

Immediate Recovery Period

• The strut provides immediate stability during the critical early healing phase
• Maintains the corrected position while allowing for proper bone healing at osteotomy sites
• Prevents unwanted movement that could lead to asymmetry or relapse

Long-Term Considerations

• Despite optimal stabilization techniques, some degree of transverse relapse should be anticipated
• Overcorrection may be necessary when planning the degree of expansion
• Regular follow-up is essential to monitor stability and address any early signs of relapse

Common Pitfalls and Caveats

• Relying solely on a palatal strap without additional stabilization may result in higher relapse rates
• Failure to address preoperative orthodontic expansion can contribute significantly to transverse relapse 2
• In cases requiring extensive transverse expansion (>4mm), consider a two-stage approach with surgically-assisted rapid palatal expansion followed by one-piece surgery 3
• The stability of the maxilla is influenced by the surgical technique, fixation method, and magnitude of expansion

By implementing a palatal strut rather than a strap, surgeons can achieve better immediate post-operative stability in two-piece LeFort osteotomy procedures, though careful planning and potential overcorrection should be considered to account for the high potential for transverse relapse.