3-Piece LeFort I Osteotomy
An osteotomy is the surgical cutting of a bone. A LeFort osteotomy involves cutting and repositioning the maxillary bone, more commonly known as the upper jaw. This procedure is named after French surgeon René Le Fort (1869–1951). Legend has it that he dropped skulls off of a French tavern roof and analyzed the resulting fracture patterns. In reality, he examined crush injuries in cadavers and found three main planes of “weakness” in the face, which correspond to where fractures often occur. These fractures are called LeFort I, II and III, and are depicted in the photo below.
The LeFort III osteotomy is designed to move the entire face forward, including portions of the eye sockets, to correct midface hypoplasia. The LeFort II osteotomy is different in that only the nose and upper jaw will move together. It is one of the rarer osteotomies because it isn’t required as often (only in 2-5% of cases, such as Treacher Collins syndrome). The LeFort I osteotomy is the most common procedure for moving the upper jaw to treat malocclusion (poor bite) due to its low complication profile and reliable, long-term results. It allows for correction in three dimensions, with the most frequent movement being advancement (forward), retrusion (setback), elongation (lowering), and impaction (raising). It is also possible to correct a tilted jaw by raising or lowering one side more than the other.
It is important to remember that LeFort I, II, or III refers to where they made the fracture happen to the skull, not the number of pieces it is made into.
The Le Fort I osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. The maxilla is fixed in its new position with titanium screws and plates. Surgery time is around three hours. The operation is frequently carried out with the mandibular Sagittal split osteotomy when it is termed a Bimaxillary Osteotomy.