Autogenous Mandibular Bone Graft for Maxillary Le Fort I Osteotomy Interpositional Gap in Orthognathic Surgery: A Technique Case Series

When occlusal alterations are not accompanied by paranasal deficiencies, mobilization of the maxilla via Le Fort I osteotomy should be made with a different design. In this preliminary report, a W-shaped osteotomy that doesn’t change the position of the maxillary bone surrounding the pyriform aperture was presented for the first time. Advantages and indications of this new procedure are discussed.

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Comparison of Autologous and Heterologous Bone Graft Stability Effects for Filling Maxillary Bone Gap After Le Fort I Osteotomy

Advances in Clinical and Experimental Medicine ◽

10.17219/acem/40450 ◽

2015 ◽

Vol 24 (2) ◽

pp. 341-348 ◽

Cited By ~ 9

Author(s):

Cengiz Eser ◽

Eyüphan Gencel ◽

Mahmut Gökdoğan ◽

Erol Kesiktaş ◽

Metin Yavuz

Keyword(s):

Bone Graft ◽

Le Fort I Osteotomy ◽

Maxillary Bone ◽

Le Fort ◽

Heterologous Bone Graft ◽

Le Fort I

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Le Fort I osteotomy for non-orthognathic surgery indications: a review

Oral Surgery ◽

10.1111/ors.12031 ◽

2013 ◽

pp. n/a-n/a

Author(s):

L. Pingarron Martin ◽

J. Arias-Gallo ◽

M. Chamorro-Pons ◽

G. Demaria-Martinez ◽

J.L. Cebrian-Carretero

Keyword(s):

Orthognathic Surgery ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Le Fort I

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Middle and Lower Facial Soft Tissue Changes after Maxillary Advancement through Conventional or High Le Fort I Osteotomy: A Case Series Study

Journal of Craniomaxillofacial Research ◽

10.18502/jcr.v6i1.1629 ◽

2019 ◽

Author(s):

Ramin Foroughi ◽

Oveis Khakbaz ◽

Mehrdad Maneshi

Keyword(s):

Case Series ◽

Mean Difference ◽

Class Iii ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Maxillary Advancement ◽

Tissue Changes ◽

Group 2 ◽

Le Fort I ◽

Group 1

Introduction Maxillary advancementis applied extensively for malocclusion class III correction.This procedure is done using one of the two methods, Conventional or High. Maxilla moves in both vertical and horizontal and only in the horizontal directions in Conventional and High method respectively, so expecting a difference in facialsoft tissue changes. In present study is a case series that describes this issue. Materials and Methods: The cases included 30 patients with class III malocclusion due to maxillary deficiency, whom underwent Le Fort I osteotomy for maxillary advancement in Shahid Beheshti Hospital in Babol, Iran during 1995 to 1995. According to surgical technique, the cases were placed in group 1 (Conventional) or group 2 (High). Maxillary advancement and changes in hard and soft tissue of the middle and lower facial regions where measured through tracing on the lateral cephalometry. Intra-group and inter-group statistical comparisons were done using SPSS20 software at significance level as 0.05. Result: The pre-surgical mean size of SNA, SNB, nasolabial and mentolabial angles was similar in two groups. In all patients, after surgery, SNA angle size was increased and SNB، nasolabial and Mentolabial angles size were decreased. The mean value of these change was similar in two groups. In group 2, the displacement of point A ‘(mean difference: 1.30 mm) and Labrale Superius (mean difference: 1.40 mm) were significantly more than group 1. The amount of displacement of SN (mean difference: 1.30 mm), Labrale Inferius (mean difference: 0.88 mm) and Pogonion (mean difference: 0.23 mm) points in group 2 was higher than that of group 1, but this difference was not statistically significant. Conclusion: It is needed strong evidence for decision about selecting High or Conventional approach maxillary advancement in terms of facial aesthetic aspects. So, further studies with larger sample sizes and cohort or quasi-experimental design is suggested

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1353 Accuracy of Surgical movements in the Le Fort I Osteotomy

British Journal of Surgery ◽

10.1093/bjs/znab259.637 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

K Nandhra ◽

A Flett

Keyword(s):

Retrospective Analysis ◽

Case Series ◽

Le Fort I Osteotomy ◽

Retrospective Case ◽

Lateral Cephalogram ◽

Le Fort ◽

Satisfactory Outcome ◽

Soft Tissue Profile ◽

Lateral Cephalograms ◽

Le Fort I

Abstract Introduction The Le Fort I osteotomy is a surgical procedure planned by a joint orthognathic team aiming to correct skeletal discrepancies of the maxilla, with subsequent soft tissue profile changes of the patient. We undertook a retrospective case series analysis of patients receiving Le Fort I surgery at a UK teaching hospital over the last four years to assess the accuracy of Le Fort I surgical movements, by comparing the actual maxillary movement with planned surgical movements. Method A retrospective analysis of patients receiving Le Fort I surgery over a 4-year period, 2016-2020, was completed. Pre- and post-surgical lateral cephalograms were traced to determine postoperative anterior maxillary movements, and these were compared to the original orthognathic plan. Based on a literature review, we created a locally established standard of surgical movement to be within 2mm of planned movement on the lateral cephalogram trace for a satisfactory outcome. Results 91% of patients undergoing Le Fort I surgery (n = 11) had postoperative maxillary movement within 2mm of the surgical plan, and the mean difference between planned and surgical movements was 1.13mm. Conclusions Our retrospective analysis shows there is good surgical accuracy demonstrated of Le Fort I maxillary advancement movements compared to their original plan. Following this, we will continue to monitor and maintain this high standard for optimal patient outcome.

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Accuracy and Safety of In-House Surgeon-Designed Three-Dimensional Printed Patient Specific Implants for Wafer-Less Le Fort I Osteotomy

10.21203/rs.3.rs-858174/v1 ◽

2021 ◽

Author(s):

Yiu Yan LEUNG ◽

Jasper Ka Chai LEUNG ◽

Alvin Tsz Choi LI ◽

Nathan En Zuo TEO ◽

Karen Pui Yan LEUNG ◽

...

Keyword(s):

Orthognathic Surgery ◽

Three Dimensional ◽

Patient Specific ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Patient Specific Implants ◽

Principal Axes ◽

Operative Complications ◽

3D Printed ◽

Le Fort I

Abstract The design and fabrication of three-dimensional (3D) -printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. The median linear deviations of the post-operative maxilla of the x, y and z axes were 0.74 mm, 0.75 mm and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw and roll were 1.40°, 0.90° and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery.

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Le Fort I osteotomy facilitated nasotracheal intubation in a patient with concha bullosa and septal deviation: a case report

10.22514/sv.2021.062 ◽

2021 ◽

Keyword(s):

Case Report ◽

Nasal Cavity ◽

Orthognathic Surgery ◽

Nasotracheal Intubation ◽

Maxillofacial Surgery ◽

Septal Deviation ◽

Concha Bullosa ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Le Fort I

Introduction: Nasotracheal intubation (NTI) is preferred for general anesthesia in maxillofacial surgery. However, NTI is often traumatic or even unsuccessful, particularly in patients with a narrow nasal pathway. In this case report, we describe a less traumatic NTI approach using maxillary downfracture of Le Fort I osteotomy. Case presentation: A 19-year-old woman was admitted with a skeletal Class III malocclusion and scheduled to undergo bimaxillary orthognathic surgery. A preoperative evaluation revealed no other medical history and abnormal laboratory findings. Preoperative computed tomography showed nasal septal deviation, concha bullosa, and turbinate hypertrophy. A nasal Ring-Adair-Elwyn endotracheal tube and a tube exchanger could not be inserted via NTI because of her narrow nasal cavity. An oral intubation was performed temporarily and surgery was started. After a maxillary downfracture was performed, which made the nasal cavity wider than before, NTI was successfully conducted without difficulty. The patient was ventilated without any problems, and the operation was continued. Postoperatively, the patient had no further complications and her vital parameters were all stable. Conclusions: This case report suggests that NTI after maxillary downfracture of Le Fort I osteotomy can be a good alternative that can be successfully performed with less trauma in patients undergoing orthognathic surgery who are preoperatively evaluated as having a narrow nasal cavity.

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Long-term Use of Le Fort I Osteotomy for the Management of Nasopharyngeal Rhinosporidiosis: A Case Series

Ear Nose & Throat Journal ◽

10.1177/0145561318097010-1103 ◽

2018 ◽

Vol 97 (10-11) ◽

pp. E36-E43

Author(s):

Vikram Shetty ◽

Akshaya Kulkarni ◽

Suman Banerjee

Keyword(s):

Nasal Mucosa ◽

Treatment Protocol ◽

Case Series ◽

Le Fort I Osteotomy ◽

Complete Excision ◽

Le Fort ◽

Long Term Follow Up ◽

Le Fort I

Rhinosporidiosis is a rare, chronic, granulomatous infection of the mucous membranes that mainly involves the nose and nasopharynx; it occasionally involves the pharynx, conjunctiva, larynx, trachea and, rarely, the skin. The characteristic clinical features of this disease include the formation of painless polyps in the nasal mucosa or the nasopharynx that bleed easily on touch. At our center, excision of the lesion with a Le Fort I osteotomy is carried out in patients (1) in whom two or more previous attempts at excision of biopsy-proven rhinosporidiosis arising from the nasal mucosa was carried out or (2) in whom the rhinosporidiosis arises from the nasophayrngeal mucosa and/or extranasal sites. In this article we retrospectively present 7 cases in which, according to our inclusion criteria, complete excision of the lesion was carried out with a Le Fort I osteotomy. Excellent visualization of the entire maxillary and ethmoidal air cells after the down-fracture of the maxilla helped in the total removal of the lesions. Most of these lesions had multiple points of origin through the nasal, maxillary, and ethmoidal mucosa; the excellent visualization enabled direct cauterization of all these points of origin. The mean follow-up period was 7.96 years, and all patients were disease-free by the time the study was prepared. This article presents details of the treatment protocol and technique followed at our center for the treatment of nasopharyngeal rhinosporidiosis and the details of long-term follow-up. Through this study we hope to prove the efficacy of Le Fort I osteotomy in the definitive management of nasopharyngeal rhinosporidiosis.

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Nasal considerations with the Le Fort I osteotomy

Orthodontic Update ◽

10.12968/ortu.2019.12.3.92 ◽

2019 ◽

Vol 12 (3) ◽

pp. 92-97

Author(s):

Timothy McSwiney ◽

Sadaf Khan ◽

Daljit Dhariwal

Keyword(s):

Risk Factors ◽

Orthognathic Surgery ◽

Restorative Dentistry ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Factors Associated ◽

Dentofacial Deformities ◽

Management Techniques ◽

Le Fort I ◽

Nasal Changes

Orthognathic surgery involves the correction of severe dentofacial deformities through a combination of orthodontics, surgery and, occasionally, restorative dentistry. This procedure, when involving surgical movement of the maxilla, can lead to changes in the overlying nasal morphology. In this paper, the standard nasal assessment that is undertaken prior to a Le Fort I osteotomy is outlined along with the reported nasal changes seen following this procedure. In addition, the various risk factors associated with adverse nasal changes are considered, as are the management techniques adopted by clinicians to minimize these changes CPD/Clinical Relevance: Clinicians should be aware of the adverse nasal changes associated with the Le Fort I osteotomy.

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