• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.32.1-32.4
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• 2020

Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.1-4
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• 2000

True midfacial deficiency is defined as a hypoplasia of various components of midface such as maxilla, orbit, zygoma and nasal bone. For treatment of these anomalies Le Fort III osteotomy and its modifications have been used traditionally. Le Fort III osteotomy is the method which advances maxilla with nasal bone and zygomatic bone at a time. At first midfacial osteotomy was introduced by Gillies to treatment of dentofacial deformity in 1950. In 1967 Tessier designed Le Fort III osteotomy according to Le Fort III midfacial fracture line and popularized to treat midfacial deficiency using coronal incision to appoach osteotomy sites. This is a case of patient who had mandibular prognathism with midfacial deficiency with severe discrepancy in maxillomandibular interrelation. First we performed Le Fort III osteomomy for zygomaticomaxillary advancement, and then carried out simultaneous two jaw surgery with Le Fort I osteotomy and BSSRO three months after first surgery.

• The korean journal of orthodontics
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• v.40 no.6
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• pp.383-397
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• 2010

Objective: The objective of this study was to compare maxillary soft tissue changes and their relative ratios to hard tissue changes after anterior segmental osteotomy (ASO)/bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion. Methods: The study sample comprised the ASO/BSSRO group (n = 14) and the Le Fort I/BSSRO group (n = 15). The Le Fort I/BSSRO group included cases of maxillary posterior impaction only. Lateral cephalograms were taken 2 months before and 6 months after surgery. Linear and angular measurements were performed. Results: The anterior maxilla moved backward in both groups after surgery, however the amount of change was significantly larger in the ASO/BSSRO group (p < 0.01). The ratios of hard to soft tissue change were 79% (SLS to A point), 80% (LS to A point) in the ASO/BSSRO group, and 15% (SLS to A point), 68% (LS to A point) in the Le fort I/BSSRO group. In addition, there was a $3.23^{\circ}$ increase of the occlusal plane in the Le Fort I/BSSRO group. Conclusions: When two-jaw surgery is indicated in skeletal Class III patients with protrusive lips, ASO may be a treatment of choice for cases with more severe upper lip protrusion, while Le Fort I with posterior impaction may be considered if an increase of occlusal plane angle is required.

• The korean journal of orthodontics
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• v.48 no.1
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• pp.63-70
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• 2018

Objective: The aim of this study is to quantitatively evaluate the stability of the skeletal and dental widths using cone-beam computed tomography (CBCT) after segmental Le Fort I osteotomy in adult patients with skeletal Class III malocclusion requiring maxillary expansion. Methods: In total, 25 and 36 patients with skeletal Class III malocclusion underwent Le Fort I osteotomy (control group) and segmental Le Fort I osteotomy (experimental group), respectively. Coronal CBCT images were used to measure the dental and skeletal widths before (T1) and after (T2) surgery and at the end of treatment (T3). The correlation between the extent of surgery and the amount of relapse in the experimental group was also determined. Results: In the control group, the dental width exhibited a significant decrease of $0.70{\pm}1.28mm$ between T3 and T2. In the experimental group, dental and skeletal expansion of $1.83{\pm}1.66$ and $2.55{\pm}1.94mm$, respectively, was observed between T2 and T1. The mean changes in the dental and skeletal widths between T3 and T2 were $-1.41{\pm}1.98$ and $-0.67{\pm}0.72mm$, respectively. There was a weak correlation between the amount of skeletal expansion during segmental Le Fort I osteotomy and the amount of postoperative skeletal relapse in the experimental group. Conclusions: Maxillary expansion via segmental Le Fort I osteotomy showed good stability, with a skeletal relapse rate of 26.3% over approximately 12 months. Our results suggest that a greater amount of expansion requires greater efforts for the prevention of relapse.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.6
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• pp.485-491
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• 2009

Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.1
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• pp.120-124
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• 1996

The postoperative maxillary cyst develops as a delayed complication after surgical intervention or Caldwell-Luc operation in the maxillary sinus and was also reported that it could occur after Le Fort I osteotomy. This is also called as surgical cliated cyst because of its lining epithelium is usually lined by a pseudo-stratfied ciliated columnar epithelium. This report represents a case of postoperative maxillary cyst which developed within the anterior of maxilla and in association with nasal mucosa 6 years after a Le Fort I osteotomy. In 1989, 26-year-old male complained of his mandibular prognathism and underwent orthogmathic surgery, Le Fort I osteotomy, bilateral sagittal split ramus osteotomy, partial glossectomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.1
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• pp.21-24
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• 2014

Maxillary sinus infection following Le Fort I osteotomy is rare in patients without a history of preexisting nasal symptoms. A case of a 19-year-old male patient who suffered from preoperative chronic non-allergic rhinitis and developed repetitive postoperative maxillary sinus infection after Le Fort I osteotomy is reported.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.97-101
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• 2015

Maxillary transverse deficiency is one of the most common deformities among occlusal discrepancies. Typical surgical methods are segmental Le Fort I osteotomy and surgically-assisted rapid maxillary expansion (SARME). This patient underwent a parasagittal split with a Le Fort I osteotomy to correct transverse maxillary deficiency. During follow-up, early transverse relapse occurred and rapid maxillary expansion (RME) application with removal of the fixative plate on the constricted side was able to regain the dimension again. RME application may be appropriate salvage therapy for such a case.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.11 no.1
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• pp.243-248
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• 1989

This is a report of 2 cases on old maxilla fractures accompanied with sagittal palatal fracture and severe malocclusion. We treated them by using of classic Le Fort I osteotomy and modified Le Fort I osteotomy along the old fracture lines satisfactorily. The results obtained from treatment are as follows : 1. Careful examination and correct care on sagittal palatal fracture should be need during initial diagnosis and emergency care of maxilla fracture showed malocclusion. 2. Although early definite treatment of maxilla injuries is difficult due to major organ injuries associated with accident, the positive effort to induce normal occlusion is always necessary as soon as possible. 3. In the cases of malocclusion due to transverse discrepancy of maxillary dentition associated with injury as like as our cases, classic and modified Le Fort I osteotomy and rigid internal fixation were useful to correct occlusion, to ease operation and return normal functions early.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.21.1-21.6
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• 2016

Background: The Le Fort I osteotomy is one of the most widely used and useful procedure to correct the dentofacial deformities of the midface. The changes of the maxilla position affect to overlying soft tissue including the nasal structure. Postoperative nasal septum deviation is a rare and unpredicted outcome after the surgery. There are only a few reports reporting the management of this complication. Case Presentation: In our department, three cases of the postoperative nasal septum deviation after the Le Fort I osteotomy had been experienced. Via limited intraoral circumvestibular incision, anterior maxilla, the nasal floor, and the anterior aspect of the septum were exposed. The cartilaginous part of the nasal septum was resected and repositioned to the midline and the anterior nasal spine was recontoured. Alar cinch suture performed again to prevent the sides of nostrils from flaring outwards. After the procedure, nasal septum deviation was corrected and the esthetic outcomes were favorable. Conclusion: Careful extubation, intraoperative management of nasal septum, and meticulous examination of preexisting nasal septum deviation is important to avoid postoperative nasal septum deviation. If it existed after the maxillary osteotomy, septum repositioning technique of the current report can successfully correct the postoperative septal deviation.