LeFort I Osteotomy and Advancement in Patient with Maxillary Hypoplasia

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Author: Aaron Smith
Published:
Specialties: Oral Maxillofacial, Otolaryngology, Pediatric Otolaryngology, Plastic Surgery
Schools: Hillsdale College, University of Arkansas for Medical Sciences
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Basic Info

Contributors: Michael Golinko, Kumar Patel and Bridget O'Leary

LeFort I osteotomy and advancement in 18y/o female patient with maxillary hypoplasia

DOI: https://doi.org/10.17797/1cu3tz50yf

Advanced

Procedure

LeFort I Osteotomy and Advancement

Indications

maxillary hypoplasia, maxillary atrophy, Angle class II or III malocclusion, facial asymmetry, obstructive sleep apnea

Contraindications

co-morbidities increasing surgical risk

Instrumentation

Setup

supine, shoulder roll with neutral head position, nasal intubation, general anesthesia, tube sutured to membranous portion of caudal septum

Preoperative Workup

preoperative orthodontics, dental impressions, CT, photos, collected; precise cuts planned and post-operative appearance simulated; History & Physical Exam, CBC, Coagulation Profile, CMP, ASA Classification

Anatomy and Landmarks

Incision made from first molar to first molar, exposing lateral and medial buttresses of the maxilla. Level of the infraorbital foramen/nerve marks superior limit of dissection. Take care with mucosal lining in dissection around the level of the piriform aperture. Expose floor of the nose and nasal septum to the level of posterior palate. Pterygomaxillary junction should limit lateral dissection. Take care during osteotomy to avoid the teeth apices [maxillary canine = longest tooth root reference (26 mm)]. Osteotomy should always be performed below the level of the inferior turbinate.
Kawamoto osteotome used to separate pterygomaxillary junction; olive osteotome used to separate the nasal septum from the maxilla.

Advantages/Disadvantages

Correction of malocclusion, better oral competence, positive aesthetic outcome. Operative risk and risk of post-op infection or regression.

Complications/Risks

Non-union of osteotomy gap, malposition of maxilla, deviation of nasal septum, operative risks (post-op infection, abscess, hemorrhage, risk associated with general anesthesia)

Disclosure of Conflicts

Non-union of osteotomy gap, malposition of maxilla, deviation of nasal septum, operative risks (post-op infection, abscess, hemorrhage, risk associated with general anesthesia)

Acknowledgements

References

Buchanan EP, Hyman CH. LeFort I Osteotomy. Seminars in Plastic Surgery. 2013;27(3):149-154. doi:10.1055/s-0033-1357112.

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