Clinical analysis and management of bone non-union after Le Fort I maxillary osteotomy: An 8-year retrospective study

This study aimed to investigate the characteristics and potential etiological factors of maxillary non-union, a rare but serious complication following Le Fort I maxillary osteotomy (LF-I). From a cohort of 1618 patients who underwent the procedure performed by a single clinical team between January 2017 and December 2024, five cases (0.31 % incidence) of non-union were identified, predominantly in females with a mean age of 29.6 years. Analysis of these cases revealed several critical risk factors. The primary surgical movements associated with non-union were maxillary retraction and impaction, which often involved separation of the pterygoid processes. A notably consistent finding was the lack of paranasal bone grafting at the osteotomy sites in four out of the five patients. Furthermore, unreliable rigid internal fixation was also a significant factor, as three patients presented with loosened titanium screws that featured fewer thread turns, compromising stability. All five patients were successfully treated with revision surgery involving fibrous tissue debridement and free autologous bone grafting, primarily harvested from the mandible, resulting in complete healing of the osteotomy sites.