LeFort Osteotomy

Introduction

LeFort Osteotomy is a surgical procedure used to treat deformities of the middle of the face, specifically the maxilla and zygoma bones. During this surgery, the upper jaw (maxilla) is surgically separated from the surrounding facial bones and repositioned to correct the deformity. The repositioning can involve moving the upper jaw in various directions, including upward, downward, forward, backward, or tilting and turning it as needed. The procedure aims to achieve proper facial alignment and function.

What to Expect During LeFort Osteotomy

Surgical Separation and Repositioning: The surgery involves carefully cutting and repositioning the upper jaw to correct the deformity. Once the desired position is achieved, the upper jaw is fixed in place using plates and screws.

Incorporation of Orthodontist: Successful LeFort Osteotomy typically requires collaboration with an orthodontist for pre-operative and post-operative care. Orthodontic treatment is crucial for correcting dentofacial deformities and ensuring proper alignment of teeth.

Combining LeFort Osteotomy with Other Surgeries

In cases of severe facial deformities, LeFort Osteotomy can be combined with Bilateral Sagittal Split Osteotomy (BSSO), resulting in a procedure known as Bi Jaw or Bi Max surgery. Additionally, LeFort Osteotomy is routinely combined with chin surgery or genioplasty to address various facial issues comprehensively.

Indications for LeFort Osteotomy Surgery

LeFort Osteotomy is indicated for the following conditions:

• Correction of malocclusion of teeth.
• Jaw (maxillomandibular) deformities.
• Facial asymmetries.
• Underdeveloped maxilla in cleft palate patients.
• Obstructive Sleep Apnea (OSA).
• Maxillary atrophy.

With LeFort Osteotomy, a wide range of mid-face deformities can be effectively corrected, allowing for the comprehensive reconstruction of the entire facial complex

Ideal Age for LeFort Osteotomy Surgery

Skeletal growth must be complete before performing orthognathic surgery. In girls, this typically occurs around 15 to 16 years of age, while in boys, it occurs around 17 to 18 years of age. Maxillary (upper jaw) growth typically stops two years earlier than mandibular (lower jaw) growth. However, surgical correction for maxillary excess during the growth period can be an exception to this rule.

Pre-operative Planning for LeFort Osteotomy

• Investigations: Various investigations are performed, including a 3D CT scan of the face, frontal and lateral face photos, cephalometric X-rays for soft tissue and bony measurements, and dental impressions.
• Analysis: A detailed analysis of skeletal, dental, and soft tissue findings is conducted, and dental models are created. A mock surgery is performed on these models to plan the surgical procedure accurately.

Contraindications for LeFort Osteotomy Surgery

Certain conditions and factors may contraindicate LeFort Osteotomy surgery, including major medical comorbidities, cardiac diseases, active dental infections, patients in the active growth phase, psychiatric diseases, uncontrolled seizure disorders, significant differences in patient and surgeon goals and expectations, smoking and substance abuse habits, and questionable blood supply to the maxilla (as seen in multiply operated patients or those with a history of radiation therapy).

Surgical Procedure of LeFort Osteotomy

The surgical procedure of LeFort Osteotomy involves several key steps:

• The procedure is performed under general anesthesia with nasal endotracheal intubation.
• An intraoral incision is made along the vestibule to preserve the attached gingiva.
• Muscles attached to the bone are carefully cut, and the periosteum (bone covering) is reflected.
• Important surgical landmarks, such as the nasal apertures, lateral nasal walls, nasal septum, nasal spine, and lateral maxillary wall, are identified.
• The upper jaw (maxilla) is cut and separated from the surrounding facial bones.
• The maxilla is moved to its predetermined position and fixed to the facial bones using plates and screws.
• Temporary inter-maxillary fixation with elastics is used to maintain occlusion.
• The incision is closed in layers with absorbable sutures.

Recovery After LeFort Osteotomy Surgery

Recovery following LeFort Osteotomy surgery includes:

• Facial swelling and bruising that typically subsides within a week.
• A soft diet for 4 to 6 weeks, starting with liquids.
• Antibiotic treatment for one week.
• The use of soft elastics to hold the upper jaw in the new position.
• Avoiding forceful nose blowing for three weeks.
• Regular follow-up visits to monitor progress.

Risks and Complications

While LeFort Osteotomy is generally considered safe, it can lead to complications, including bleeding, infections, occlusal changes, dental and periodontal injuries, fistulas, nerve injuries, changes in facial appearance, nasal airway issues, pain, and congestion. Extremely rare complications may include maxillary necrosis, unilateral blindness, and oculomotor nerve palsy.

Patients should consult with Dr.Amit for a thorough evaluation and to discuss the potential risks and benefits of LeFort Osteotomy surgery in their specific case.