Symptoms for LeFort Osteotomy Surgery

• Correction of malocclusion of teeth.
• Maxillomandibular (Jaw)Deformities.
• Facial Asymmetries.
• Underdeveloped maxilla in Clefts.
• Obstructive Sleep Apnea.
• Maxillary Atrophy.

Pre operative planning at Kayakriti

Preoperative surgical planning is the key to successful orthognathic surgery

A) Investigations

• 3D CT scan of the face
• Frontal and lateral photos of the face
• Cephalometric X-Ray of the face for soft tissue and bony measurements.
• Dental impressions are obtained to aid in formulating a diagnosis.

Out of all the mentioned investigations, Cephalometric X-rays are very important as they reveal abnormal growth patterns of the upper and lower jaws about the cranial base.

B) Analysis

Then a detailed analysis of the skeletal, dental, and soft tissue findings is done by Dr. Amit Agarwal and the orthodontist. Dental models are made and a mock surgery is performed over the model and acrylic occlusal splints are fabricated. These occlusal splints are used intraoperatively to accurately reposition the osteotomized (cut) upper jaw - maxilla.

10 Steps for Surgical Procedure of LeFort Osteotomy

• This procedure is performed under general anesthesia with nasal endotracheal intubation. Local anesthesia (lidocaine 1% with 1:100,000 epinephrine) is also used to decrease blood loss.
• During maxillary down fracture, the technique of hypotensive anesthesia will also lead to decreased blood loss.
• A vestibular intraoral incision is given to preserve the attached gingiva.
• The muscles attached to the bone are cut with a fine cautery and the periosteum which is the covering of the bone is reflected up.
• The important surgical bony landmarks are brought into view which includes the piriform nasal apertures, the lateral nasal walls, the nasal septum and vomer, the anterior nasal spine, the infraorbital foramen, and neurovascular bundle, and the lateral maxillary wall.
• The upper jaw (maxilla) is then cut and separated from the remaining facial bones and moved to its desired location which has been decided preoperatively.
• The most common separation is a Horizontal cut (Osteotomy) in which the surgeon uses the reciprocating saw to a cut (osteotomy) through the maxilla.
• A lot of care is taken to know the location of the apices of the tooth and the pterygoid plates posteriorly while cutting. Proper clinical examination & X-rays are required to prevent damage to the teeth due to the maxillary separation.
• If the gap between the bones is more than a centimeter and where a large gap exists between the segments after fixation, then bone grafting is done to prevent relapse and to provide long-term stability.
• Temporary inter-maxillary fixation with elastics is done over pre-surgically made occlusion wafers. The surgically moved maxilla is fixed with the native bones of the face with the help of plates and screws and the incision is closed in layers with absorbable sutures.

A) Le Fort Osteotomy in Cleft Patients

Le Fort 1 Osteotomy with horizontal advancement is done for cleft children after their skeletal growth is complete. It is the last stage of correction in cleft patients. As cleft patients mostly have a Class III malocclusion with narrow dental arch & palatal collapse, their facial height is also reduced.

Though Le Fort 1 Osteotomy with advancement is the standard method in many cases Segmental Le Fort 1 Osteotomy with Orthodontic Rapid Palatal Expansion has also been advised.

B) Le Fort Osteotomy in Class II Deformity

This deformity is mostly seen in cases of the underdeveloped or retruded mandible. In most of the cases, mandibular advancement & genioplasty is done but Le Fort 1 Osteotomy & repositioning is also advised in a few cases along with mandibular advancement.

C) Lefort Osteotomy in Gummy Smile Patients

Patients with an increased vertical height of the maxilla are also benefited from this surgery as this surgery helps to decrease the height of the upper jaw in the vertical direction which reduces the gingival show.

D) Lefort Osteotomy in Obstructive Sleep Apneoa (OSA)

Airway obstruction in case of Obstructive sleep apnea can also be well treated with this surgery. The airway is first properly evaluated with proper investigations, to determine the cause of OSA and to know if there is a skeletal obstruction for which advancement of the upper jaw can be done to increase the volume of the oro- & nasopharyngeal airway. This procedure in selected patients gives relief to them from OSA.

E) Le Fort Osteotomy in Asymmetry of the Jaws

In combination with Bilateral Saggital Split Osteotomy (BSSO), Le Fort Osteotomy is used for the correction of asymmetries. These asymmetries usually result due to condylar hyperplasia during the growth phase of the maxilla & mandible.

How much time does it take to Recover?

The patient is wheeled out of the operation theatre in stable condition and kept in the post-operative recovery room for overnight monitoring. Facial swelling and bruising are common after this surgery which surely subsides within a week. Ice packs may be applied in the early postoperative period to minimize swelling.

What to do for faster Recovery?

• Soft diet for 4 to 6 weeks starting with liquids for about a week.
• Antibiotic treatment is continued for one week.
• Soft elastics are placed between the upper and the lower jaw to hold the upper Jaw in the new position.
• The patient is instructed to avoid forceful nose blowing for three weeks
• The patient is usually discharged after 3 to 4 days from the hospital and is instructed to follow up after a week
• Early postoperative occlusal changes which may be due to edema and muscular re-adaptation are common.
• The patient is to follow a strict postoperative regimen
• Thorough oral hygiene is critical with the use of a soft toothbrush and antibacterial mouth rinse.

Postsurgical Orthodontics

The main role of postsurgical orthodontics is to settle teeth into their final occlusion. The length of postoperative orthodontic treatment will vary, depending on the presurgical set-up, the accuracy of planned surgical movements, and the final occlusal result. A general goal by most orthodontists is to complete all postsurgical orthodontics within 9 months.