Lefort Osteotomy PPT (Ing)

LeFort I Osteotomy
Oleh :
The LeFort I osteotomy is commonly used for the
correction of malocclusion and maxillomandibular
I N D I C AT I O N S deformities  class II and III malocclusions, as
well dentofacial asymmetries.
It is associated with maxillary hypoplasia and is
commonly found in patients with orofacial clefts,
obstructive sleep apnea (OSA), and maxillary atrophy.
LeFort 1 osteotomy with horizontal advancement is used

for the majority of patients to correct their malocclusion.
If left untreated, the maxillary hypoplasia can lead to

superior rotation of the mandible, reducing the facial
height and upwardly tilting the occlusal plane.
I N D I C AT I O N S
Class III malocclusion is one of the most common reasons for
performing a LeFort I osteotomy.
I N D I C AT I O N S
LeFort I osteotomy + bilateral sagittal

Severe class II deformities due to
split osteotomy (BSSO)  secondary
mandibular retrognathism  LeFort
maxillary effects seen in asymmetrical
1 osteotomy and repositioning +
mandibular deformities, attributed to
mandibular advancement and
unilateral mandibular condylar
osseous genioplasty.
hyperplasia.
LeFort I osteotomy is also used for

Patients suffering from vertical maxillary
maxillary atrophy and obstructive sleep
excess (VME) or deficiency will benefit
apnea. Autogenous iliac bone grafts +
from the osteotomy by decreasing the
LeFort 1 osteotomies  rehabilitate
vertical position of the maxilla and the
the atrophied, edentulous mandible for
amount of gingival show.
osteointegrated implants.
TECHNIQUE
The patient is placed in a supine position This is commonly done via a tattoo at the
with a shoulder roll for a neutral head level of the medial canthus or a K-wire
position. Nasotracheal intubation is preferred. placed at the level of the nasofrontal junction.
The tube is usually secured with a 2.0 silk Preoperative measurements of the maxilla
suture to either the membranous portion of from the teeth or orthodontic brackets should
the caudal septum or the anterior scalp. be obtained on both the left and right.
External facial landmarks are important to Local anesthesia is then injected into the
establish prior to beginning the procedure. gingivobuccal sulcus of the upper lip to help
with hemostasis.
The incision is made with the purpose of leaving a
healthy cuff of sliding gingiva. The cuff will always
appear shorter after it is cut  avoid the
embarrassing complication
Once through the mucosa and into the loose

areolar tissue in the submucosal plane,
dissection should proceed directly to bone.
The incision is made from first molar to

first molar, to expose both the lateral and
medial buttresses of the maxilla.
TECHNIQUE When the periosteum is identified, it should be

scored with electrocautery for the entire length of
the incision. Subperiosteal dissection with an
elevator is performed.
TECHNIQUE
• After the maxilla is exposed, • The osteotomy is made with a • Once the osteotomies are
reference points should be made reciprocating saw at the lateral completed, the downfracture is
on the maxilla to help achieve maxillary buttress and directed to performed with digital pressure.
the preoperative plan. the ipsilateral piriform rim.
• Downfracturing the maxilla will

• The aesthetic needs of the • The same osteotomy is allow for further dissection of the
patient will help determine where performed on the contralateral nasal floor and nasal mucosa.
the medial and lateral side.
osteotomies are made.
• Now that the maxilla is free, the
• A thin osteotome is then used to soft tissue should be stretched to
• The osteotomy should then be complete the posterior allow for greater range of motion.
marked on the maxilla with a osteotomies of the lateral and
sterile pencil or with a high- medial maxillary buttresses.
speed bur.
TECHNIQUE
Once downfracture and mobilization are complete, the

aesthetic needs and preoperative planning will determine
the new position of the maxilla. If impaction is planned, the
appropriate amount of anterior maxillary bone, septum,
and vomer should be reduced to provide for a stable base
The desired movements are made in relation to the and prevent nasal septal deviation.
external reference points measured preoperatively. If a
surgical splint has been fashioned preoperatively, it is then
used to position the maxilla by placing the patient in
maxillomandibular fixation (MMF).
The patient is released from MMF and the occlusion is
checked. The maxillary midline is checked in relation to the
external reference points and the central incisors are
checked in relation to the mandibular incisors.
TECHNIQUE
After ensuring proper occlusion, the

A V-Y advancement of the mucosa
incision is closed with an absorbable
tissue can be done to help prevent a flat
suture. This is done with a 3.0 or 4.0
upper lip. This helps recreate the upper-
Vicryl suture in a horizontal mattress-
lip pout especially after a large
type fashion to ensure a watertight
horizontal movement.
closure.
The patient will spend one night in the

Postoperatively, a nasogastric (NG) tube
hospital to help with pain and nausea.
is kept in for 24 hours to help prevent
At 24 hours, the NG tube is removed
nausea. The patient is placed in a
and the patient is discharged if he or
heads-up position and given a handheld
she is tolerating liquids, ambulating,
suction.
and pain is controlled.
Segmenting the Maxilla
If the transverse dimension of the maxilla needs to be changed or if there are steps
in the occlusion, a segmental LeFort 1 osteotomy can be performed.
The sequence of this procedure commences after downfracturing the LeFort 1 segment.
The most common segmentation is the paramedian osteotomy. This osteotomy avoids
the midline to avoid the thicker bone and thinner mucosa of the maxilla.
The technique involves the surgeon placing his or her finger on the palatal mucosa
and using the reciprocating saw to make the osteotomy through the maxilla.
Once the osteotomy is completed, the segments are mobilized and a prefashioned
splint is used to position the maxilla in the appropriate place.
It is important to leave these patients in their occlusal splint for 4 to 6 weeks to

provide the maxilla with extra support while healing
LeFort 1 Distraction Osteogenesis
Distraction osteogenesis can be used in combination with LeFort 1 osteotomy to
correct patients with significant maxillary hypoplasia and class III malocclusion
greater than 1 cm and a normal mandibular position.
If distraction osteogenesis is decided, the LeFort 1 osteotomy is performed as

described above. The procedure differs once the downfracture has been completed.
The same amount of mobilization of the maxilla is not required. Distraction can be
achieved via an internal or an external approach.
The internal distraction systems are buried underneath the mucosa and are less
cumbersome after surgery.
The external distraction system provides for a greater degree of versatility because
it is secured to the cranium and can be adjusted during the activation period.
C O M P L I C AT I O N S
Patients with major anatomical irregularities, such
as cleft lip and palate, were more likely to
experience complications. These patients,
representing 11.5% of the population, experienced
nearly half the complications.
O U T C O M E S D ATA
 A study of LeFort I maxillary advancement  Horizontal relapse rates after maxillary

without additional surgeries or associated advancement have been reported as high as 37% of
syndromes found that only 14% of patients had the overall movement, whereas vertical relapse
clinically significant relapse (> 2 mm). rates are as high as 65%.
 Patients treated for vertical maxillary excess had  One meta-analysis found that the average distance
a similar relapse rate. In the majority of cases, of relapse was 25 to 30% of the total movement.
relapses occur during the first 6 months.
 As a result of the gradual movement and
progressive bone generation, distraction
 The biggest risk factor in predicting relapse is osteogenesis was shown to be more stable with a
the distance of maxillary movement. relapse rate of 8.24% of the total movement.
• The LeFort I osteotomy of the maxilla is one of
the core procedures in orthognathic surgery for
the management of facial skeletal deformities.
• Traditionally, the surgery has been known for its

CONCLUSIONS low technical difficulty and dependable results.
• An emphasis should be placed on proper

presurgical orthodontics and solid presurgical
planning to ensure predictable and stable
results.
THANK YOU!
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LeFort I Osteotomy

LeFort 1 osteotomy with horizontal advancement is used

If left untreated, the maxillary hypoplasia can lead to

LeFort I osteotomy + bilateral sagittal

LeFort I osteotomy is also used for

Once through the mucosa and into the loose

The incision is made from first molar to

TECHNIQUE When the periosteum is identified, it should be

• Downfracturing the maxilla will

Once downfracture and mobilization are complete, the

After ensuring proper occlusion, the

The patient will spend one night in the

It is important to leave these patients in their occlusal splint for 4 to 6 weeks to

If distraction osteogenesis is decided, the LeFort 1 osteotomy is performed as

 A study of LeFort I maxillary advancement  Horizontal relapse rates after maxillary

• Traditionally, the surgery has been known for its

• An emphasis should be placed on proper

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