Le Fort I Osteotomy
Sensory nerves to the upper lip and cheeks are coloured blue
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.
Bimaxillary osteotomies take around five hours to complete and may be carried out in conjunction with chin surgery and liposuction/liposculpture. Blood transfusion is required. On occasions bone grafting is required in the Le Fort I osteotomy to ensure bone healing and union across the bone cuts. The graft is frequently harvested from the hip. Bone graft material may be harvested from the chin or lower jaw in bimaxillary cases – leaving the hip intact.
Cosmetic improvement is startling for those individuals requiring these procedures, and with proper planning it is unusual for patients not to be delighted with outcome.
Mandibular Sagittal Split Osteotomy
The back of the lower jaw is split bilaterally under general anaesthetic in the region of the wisdom teeth, which are generally removed in a separate operation at least 6 months prior to corrective surgery.
The procedure is carried out in about 1.5 hours and permits the lower jaw to be advanced or pushed back with adequate bone contact for healing.
The bone is fixed in its new position by screws which are inserted through tiny external skin incisions which are located at the angle of the jaw. These heal with minimal external scarring.
Mandibular Sagittal Split Osteotomy
and Genioplasty (Chin Surgery)
The mandible has been pushed backwards and surgery has been carried out to the chin (Genioplasty)Sensory Nerves to the lower lip pass through the jaw and are coloured blue
Whilst day case treatment is practiced in the USA, it is common practice in the UK to spend one night as an in-patient.
Some adjustment to the position of the dental occlusion (bite) is not uncommon following surgery. This is achieved by joining the upper and lower jaws together with elastic band traction for a week or two.
Facial swelling is variable and is controlled with intravenous steroid injections over the first 24 hours. Patients require a liquidised diet if the jaws are held together with elastics - or soft diet for the first two weeks, after which time more solid food can be introduced.
Specific Complications:
The Mandibular Sagittal Split Osteotomy
The sensory nerves to the lower lip are coloured blue.
Screw fixation is demonstrated on one side. Screws are placed above and below the nerve
