Le Fort I osteotomy

The procedure involves a horizontal osteotomy of the maxilla, separating it from the skull base at the level of the Le Fort I fracture line.

This allowed for controlled movement of the tooth-bearing portion of the maxilla in multiple directions (anteroposteriorly, vertically, rotationally) and permited segmentation or expansion.

[1][2][4] Subsequent developments in surgical techniques, understanding of revascularization, and the integration of orthodontics and fixation methods have influenced the use of the Le Fort I osteotomy.

These include maxillomandibular deformities such as maxillary hypoplasia (underdevelopment of the bones of the upper jaw) and mandibular hyperplasia (overdevelopment of the mandible) as well as facial asymmetries.

Certain cases of an open bite malocclusion (apertognathia), a condition where the front teeth do not meet when the jaw is closed, can also be corrected with this procedure.

The Le Fort I osteotomy can also be used to gain surgical access for the removal of tumors in the midface or skull base or to facilitate the reduction of complex midfacial fractures.

[1][2] Preoperative planning for the Le Fort I osteotomy is performed and typically involves detailed facial analysis, imaging, and often the creation of surgical splints.

The horizontal cut is made above the roots of the teeth, extending from the lateral maxillary buttress (the bony prominence on the side of the maxilla) to the piriform rims (near the opening of the nasal cavity).

This repositioning can involve moving the maxilla forward (advancement), backward (retraction), upward (impaction), downward (down-grafting), or rotating it.

[2] The Le Fort I osteotomy, while generally considered a technically straightforward surgery, carries a risk of complications, albeit infrequent.

Ischemic complications, such as avascular necrosis (bone death due to lack of blood supply), can also occur and are more likely with large advancements or segmental osteotomies.