Le Fort osteotomy

Le Fort osteotomy is a surgical procedure used in maxillofacial surgery to correct irregularities of the midface and upper jaw. Named after the French surgeon René Le Fort, who classified facial fractures in the early 20th century, this operation involves cutting the bone to allow movement of the upper jaw (maxilla) to a more favorable position. This procedure is often indicated for patients with congenital defects, growth disturbances, or trauma-related deformities affecting the maxilla and can significantly improve both function and facial aesthetics.

Types of Le Fort Osteotomy

Le Fort osteotomy is categorized into three main types, based on the level of the maxilla where the bone is cut:

• Le Fort I osteotomy: This is the most common type, involving a horizontal cut above the teeth to move the entire upper jaw forward, backward, or to correct asymmetry.
• Le Fort II osteotomy: A pyramidal-shaped osteotomy that includes the nasal bridge, allowing for correction of midface deficiencies or excesses.
• Le Fort III osteotomy: This involves a series of cuts through the cheekbones and the base of the orbit, allowing for the advancement or repositioning of the midface and upper jaw as a single unit.

Indications

Le Fort osteotomy is indicated for various conditions, including but not limited to:

• Cleft palate and other congenital craniofacial anomalies
• Malocclusion not correctable by orthodontics alone
• Midface hypoplasia or retrusion
• Obstructive Sleep Apnea (OSA) where maxillomandibular advancement is required
• Facial asymmetry
• Post-traumatic facial deformities

Procedure

The Le Fort osteotomy procedure is performed under general anesthesia. The surgeon makes incisions inside the mouth to expose the facial bones and performs the osteotomies according to the preoperative planning. The upper jaw is then moved into the desired position and stabilized with plates and screws. The procedure may be combined with other surgeries, such as genioplasty (chin surgery) or rhinoplasty (nose surgery), to achieve optimal facial harmony. Recovery involves a period of swelling and discomfort, with a gradual return to normal activities and diet.

Risks and Complications

As with any major surgery, Le Fort osteotomy carries risks, including infection, bleeding, nerve damage leading to numbness, and relapse of the bone to its original position. However, with careful surgical planning and postoperative care, these risks can be minimized.

Conclusion

Le Fort osteotomy is a critical procedure in the field of maxillofacial surgery, offering significant improvements in function and appearance for patients with midface and upper jaw irregularities. Through careful planning and execution, this surgery can enhance the quality of life for those affected by congenital, developmental, or traumatic facial deformities.