In this systematic review of 48 articles the authors reviewed the complication, stability, aesthetics and healing of Le Fort I, sagittal split, chin and zygomatic osteotomies. They concluded that there was strong evidence that bone grafting promotes healing of a Le Fort I and sagittal split osteotomies, and acceptable evidence for the chin and zygomatic procedures. Increased stability was found in the Le Fort I, chin and zygomatic osteotomies, however there was no evidence for such a claim for sagittal split osteotomy. There was evidence that grafting did reduce the inferior border irregularities. They noted calcium phosphate increases the rate of infection and hydroxyapatite to a lesser extent in the mandible. They concluded that grafting can be recommended in maxillary and mandibular advancements of more than 5 and 8mm respectively, inferior repositioning of the maxilla and chin of greater than 5mm and all intraoperative palpable osteotomy gaps at the sagittal and chin osteotomy sites.

Bone grafting in orthognathic surgery: a systematic review.
Alyahya A, Swennen GRJ.
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Stuart Clark

Manchester Royal Infirmary, Manchester, UK.

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