Estabilidade e complicações pós-operatórias em osteotomia le fort i associada ao uso de substitutos ósseos - revisão sistemática

Abstract

This review systematic was conducted to evaluate the stability and postoperative complications of Le Fort I osteotomy with the use of bone grafting in order to improve the understanding of this technique and to investigate the need for new methodologies on the subject. The systemmatic search was carried out in PubMed, EMBASE, Cochrane Library databases, grey literature (Opengrey, Register of clinical trials and Google scholar) and manual search, yielding 1748 articles published up until 2019. Of these, 72 articles were selected for full-text screening, but only 23 articles were included. The level of agreement between the authors for study selection and for eligibility was considered excellent (k = 0.891 and k = 0.907 respectively). Methodological quality was considered low, with all studies including high bias potential. Even so, the study highlights that the bone grafting reduces the rate of relapse by providing results of stable measurements in the sagittal and vertical planes of the maxilla. These stability results allowed us to organize a stratified categorization of the surgical movements in both planes of the maxilla, stating that the bone graft may be well indicated for maxillary advancement > 5 mm and inferior repositioning ≥ 3 mm. The most frequent postoperative complications were HA block displacement, donor site scarring and sinusitis. The allogeneic and alloplastic grafts presented a higher prevalence regarding complications with rate of 6.1% and 5% respectively. Therefore, this grafting technique presents a low complication rate and is considered safe. Despite the guidelines proposed in this systematic review, there were small samples in some studies, heterogeneity in methods and results, few clinical trials with xi controlled group and use of 2D overlap of surgical changes. This indicates that more robust, evidence-based research is needed to support these results.