Retrospective Comparative Study of Lefort I Osteotomies With External or Internal Maxillary Distraction Devices

Introduction: This investigation aims to evaluate outcomes of LeFort I distraction osteogenesis (DO) using external distraction (ED) versus internal distraction (ID), focusing on acute complication rates and relapse/malocclusion necessitating a secondary LeFort I osteotomy. Factors associated with a higher likelihood of complication and secondary surgery are also described. Methods: A retrospective review of 467 electronic medical records was conducted for patients who underwent at least one maxillary or mandibular orthognathic procedure between 2003 and 2023. Results: Among these patients, 17% (79/467) underwent LeFort I with maxillary distraction and had at least 30 days of follow-up for acute complications. Eleven percent (50/467) underwent LeFort I with maxillary distraction and had at least 2 years of follow-up for the likelihood of a secondary LeFort I procedure. A statistically significant difference was seen in the number of acute complications for patients who used ED versus ID devices after LeFort I osteotomy with distraction. The need for secondary LeFort I osteotomy was not significantly different between patients using ED and ID devices. Conclusion: The complication and reoperation rates reported here may help counsel patients and families about potential outcomes and expectations for LeFort I advancement using ED and ID devices, as well as provide a point of comparison for future investigations.