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Mostly water but I made it in school today so I wanted to post it
Lefort 1 Osteotomy
Used to advance the lower maxilla to improve both aesthetics and function. The horizontal cut is situated above the dental root tips, below the infraorbital foramen, through the maxillary sinuses, and below the zygomatic region. The cut is made in the mouth above the top teeth. It allows for correction in three dimensions including advancement, retrusion, elongation, and shortening. Counter clockwise and clockwise rotation of the maxilla is also possible
Changes to the maxilla
Widening: Widening can be achieved through a parasaggital split through the maxilla. This is a vertical split parallel to the sagittal plane, which divides the maxilla into two halves. This is usually only done in extreme cases and is very niche, but it could be possible if you find a surgeon that would perform such an operation.
Advancement/retrusion: Retrusion is usually never necessary. Advancement is usually the goal of a lefort 1 osteonomy and the maxilla is usually advanced within the range of 4-10 mm. Advancement in lefort 1 is inferior to that of lefort 2 and 3, but it is a much cheaper, safer, and more accessible option. Keep in mind that lefort 1 does not directly entail the nasal and orbital area and therefore does not give optimal asthetical results.
![M/21/6'2 [164>163] 1 year post lefort 1 and Bilater sagital split osteotomy jaw surgery : r/progresspics](/proxy.php?image=https%3A%2F%2Flh7-rt.googleusercontent.com%2Fdocsz%2FAD_4nXeY4ZYDIr2wzkCZWRWSLoiIjouhVSjrr5CF6ylsNTWAYLXz9hDx46TGpYOjIjlRRDBIetAN789dhai4zHZe3geA1LKqFQTvHgAUNVkueMWeKf38BxlToLhmR7a_jbghVunpGsEvoVOu80ld1oAY63zA8Jrb%3Ds320%3Fkey%3DfawWgPXW4bzTJTZPT44g_g&hash=7eefa4588875b73f57775bf0498561b5 "M/21/6'2 [164>163] 1 year post lefort 1 and Bilater sagital split osteotomy jaw surgery : r/progresspics")
Bimax result from reddit, midface changes are obvious.
Another bimax result from reddit.
High Cut Lefort 1
A high cut lefort 1 would give similar results to that of a lefort 2 but still does not attack the nasal area. There are close to zero examples of a surgery like this actually being performed and a lefort 2 would be the surperior version of this. The cuts are located below the infraorbital foramen and orbital rims and while it would give better asthetic results than regular lefort 1 I do not think that it would be optimal.
Elongation/shortening
Involves a ccw (counter-clockwise) or cw (clockwise) rotation of the maxilla. This rotation can elongate or shorten the perceived view of the midface which would benefit people with a overly long midface or sfs (short face syndrome).
CCW
CW (I think?)
Changes to the nose
Lefort 1 can potentially change nose width and tip position, which could give positive or negative aesthetic results. CCW lefort 1 especially can lead to significant widening of the alar base, which would make the nose appear wider and would have to be fixed with a rhinoplasty. According to the NHIS, “The mean alar base width pre-operatively was 14.11 mm and post-operatively was 15.28 mm. The mean increase in alar base width was 1.176 mm.” To combat this, an alar cinch technique can be used, where the alar base is sutured to the surrounding facial structure which would effectively prevent the alar base from widening. The nasal tip can also change as a result of this surgery, but the effects are rather unknown.
Soft Tissue
Soft tissue in the nasolabial and upper lip area are possible and are rather unpredictable. Soft tissue changes can be predicted with modern technological advancements in orthognathic surgery, but there is no way to fully decipher soft tissue changes after surgery.
Custom plates
Custom plates can be used to lock the maxilla into its new position. Contrary to the usual L shaped plates, custom X Y plates can be used to give an optimal fit, reduce surgery time, and give a better functional and asthetic result. These custom plates do cost more than standard L plates however.
DON’T GET THIS IF YOU ARE STILL GROWING
“Le Fort I osteotomies for the normal growing maxilla or the deficient growing maxilla effectively eliminates further AP growth, although vertical alveolar growth remains essentially unchanged.” (ScienceDirect)
AP = Anteroposterior (forward and backward)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805729/#:~:text=LeFort%20I%20is%20used%20to,with%20the%20LeFort%201%20osteotomy.
https://www.sciencedirect.com/topics/nursing-and-health-professions/le-fort-i-osteotomy
https://www.researchgate.net/figure/In-some-cases-a-high-Le-Fort-I-osteotomy-is-required-for-advancement-of-the-entire_fig10_30797997
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954927/
https://plasticsurgerykey.com/le-fort-i-osteotomy-and-advancement/
https://faculty.washington.edu/jeff8rob/trauma-radiology-reference-resource/2-hn/maxillofacial-buttresses/
https://www.researchgate.net/figure/Fixation-methods-A-B-Conventional-L-shaped-titanium-mini-plate-fixation-C-D_fig1_366143884
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-024-08162-1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407611
Lefort 1 Osteotomy
Used to advance the lower maxilla to improve both aesthetics and function. The horizontal cut is situated above the dental root tips, below the infraorbital foramen, through the maxillary sinuses, and below the zygomatic region. The cut is made in the mouth above the top teeth. It allows for correction in three dimensions including advancement, retrusion, elongation, and shortening. Counter clockwise and clockwise rotation of the maxilla is also possible
Changes to the maxilla
Widening: Widening can be achieved through a parasaggital split through the maxilla. This is a vertical split parallel to the sagittal plane, which divides the maxilla into two halves. This is usually only done in extreme cases and is very niche, but it could be possible if you find a surgeon that would perform such an operation.
Advancement/retrusion: Retrusion is usually never necessary. Advancement is usually the goal of a lefort 1 osteonomy and the maxilla is usually advanced within the range of 4-10 mm. Advancement in lefort 1 is inferior to that of lefort 2 and 3, but it is a much cheaper, safer, and more accessible option. Keep in mind that lefort 1 does not directly entail the nasal and orbital area and therefore does not give optimal asthetical results.
High Cut Lefort 1
A high cut lefort 1 would give similar results to that of a lefort 2 but still does not attack the nasal area. There are close to zero examples of a surgery like this actually being performed and a lefort 2 would be the surperior version of this. The cuts are located below the infraorbital foramen and orbital rims and while it would give better asthetic results than regular lefort 1 I do not think that it would be optimal.
Elongation/shortening
Involves a ccw (counter-clockwise) or cw (clockwise) rotation of the maxilla. This rotation can elongate or shorten the perceived view of the midface which would benefit people with a overly long midface or sfs (short face syndrome).
Changes to the nose
Lefort 1 can potentially change nose width and tip position, which could give positive or negative aesthetic results. CCW lefort 1 especially can lead to significant widening of the alar base, which would make the nose appear wider and would have to be fixed with a rhinoplasty. According to the NHIS, “The mean alar base width pre-operatively was 14.11 mm and post-operatively was 15.28 mm. The mean increase in alar base width was 1.176 mm.” To combat this, an alar cinch technique can be used, where the alar base is sutured to the surrounding facial structure which would effectively prevent the alar base from widening. The nasal tip can also change as a result of this surgery, but the effects are rather unknown.
Soft Tissue
Soft tissue in the nasolabial and upper lip area are possible and are rather unpredictable. Soft tissue changes can be predicted with modern technological advancements in orthognathic surgery, but there is no way to fully decipher soft tissue changes after surgery.
Custom plates
Custom plates can be used to lock the maxilla into its new position. Contrary to the usual L shaped plates, custom X Y plates can be used to give an optimal fit, reduce surgery time, and give a better functional and asthetic result. These custom plates do cost more than standard L plates however.
DON’T GET THIS IF YOU ARE STILL GROWING
“Le Fort I osteotomies for the normal growing maxilla or the deficient growing maxilla effectively eliminates further AP growth, although vertical alveolar growth remains essentially unchanged.” (ScienceDirect)
AP = Anteroposterior (forward and backward)
General complications of any operation
- bleeding
- bruising and swelling of your jaw, mouth and nose
- infection of the surgical site (wound)
- allergic reaction to the equipment, materials or medication
- blood clot in your leg
- blood clot in your lung
- chest infection
Specific complications of this operation
- numbness of the upper lip and gum
- the jaw not separating as planned
- not being able to open your mouth fully (trismus) and jaw stiffness
- slipping of the jaw bones in the first few weeks after the operation
- cosmetic problems
- infection of the plates and screws
- (https://www.healthdirect.gov.au/surgery/maxillary-le-fort-1-osteotomy)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805729/#:~:text=LeFort%20I%20is%20used%20to,with%20the%20LeFort%201%20osteotomy.
https://www.sciencedirect.com/topics/nursing-and-health-professions/le-fort-i-osteotomy
https://www.researchgate.net/figure/In-some-cases-a-high-Le-Fort-I-osteotomy-is-required-for-advancement-of-the-entire_fig10_30797997
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954927/
https://plasticsurgerykey.com/le-fort-i-osteotomy-and-advancement/
https://faculty.washington.edu/jeff8rob/trauma-radiology-reference-resource/2-hn/maxillofacial-buttresses/
https://www.researchgate.net/figure/Fixation-methods-A-B-Conventional-L-shaped-titanium-mini-plate-fixation-C-D_fig1_366143884
https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-024-08162-1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8407611
