A Le Fort osteotomy is a specialized surgical procedure performed by oral and maxillofacial surgeons to correct significant deformities of the upper jaw, also known as the maxilla, and the midface. This surgery involves making precise cuts to the bones, allowing for their repositioning. The primary goal is to realign the upper jaw to improve both its functional capabilities and the overall balance and harmony of the facial appearance.
This procedure addresses issues that can impact a person’s ability to chew, speak, or breathe properly. By carefully moving the maxilla forward, backward, upward, or downward, surgeons can correct underlying skeletal imbalances.
Medical Reasons for the Procedure
Le Fort osteotomy corrects various medical conditions affecting the midface and upper jaw. One common reason is severe malocclusion, an improper bite where the upper and lower teeth do not align correctly. This can manifest as an open bite (front teeth do not meet), an underbite (lower jaw protrudes past the upper), or a crossbite (some upper teeth sit inside the lower teeth).
Obstructive Sleep Apnea (OSA) is another significant medical indication for a Le Fort osteotomy, often performed with lower jaw surgery. Advancing the midface and upper jaw can widen the upper airway, providing a solution for severe breathing difficulties during sleep that have not responded to other treatments.
Congenital deformities, such as cleft lip and palate, or syndromic craniosynostosis like Apert or Crouzon syndrome, frequently necessitate Le Fort osteotomies. These conditions often involve underdeveloped or improperly positioned midfacial bones, leading to functional challenges and distinct facial appearances.
The surgery is also employed in cases of post-traumatic facial injuries to repair and reconstruct the midface after severe fractures. This helps restore the original facial structure and function. Aesthetic improvements are a direct consequence of correcting an underlying functional or structural issue.
The Different Types of Le Fort Osteotomies
The Le Fort osteotomy procedure is categorized into three main types, each distinguished by the specific pattern of bone cuts and the portion of the midface that is mobilized. These classifications are based on the fracture patterns initially described by René Le Fort in 1901.
Le Fort I osteotomy is the most frequently performed type, primarily addressing issues of the upper jaw, or maxilla. In this procedure, the surgeon makes a horizontal cut above the roots of the upper teeth, extending from the lateral maxillary buttress near the cheekbones to the piriform rims. Additional cuts separate the maxilla from the nasal septum and the pterygomaxillary junction, allowing the entire tooth-bearing segment of the upper jaw to be separated and moved as a “floating maxilla.” This allows for repositioning the upper jaw forward, backward, upward, or downward.
Le Fort II osteotomy involves a more extensive, pyramidal fracture pattern, separating the nasal complex and upper jaw together. The surgical cut originates from the bridge of the nose (nasion) and extends downward through the eye sockets, involving the lacrimal bones, orbital floor, and inferior orbital rims, before continuing posteriorly above the hard palate and through the pterygoid plates. This procedure is for deformities or fractures that encompass this specific midfacial region.
The Le Fort III osteotomy is the most comprehensive of the three types, often referred to as a “craniofacial disjunction” because it separates the entire midface from the cranium. The bone cuts run across the top of the nasal bridge, through the medial and lateral walls of the orbits, across the zygomatic arches, and then through the pterygoid plates. This extensive mobilization allows the surgeon to advance the entire midfacial skeleton, including the upper jaw, nose, and cheekbones, as a single unit.
The Surgical and Recovery Process
The journey through a Le Fort osteotomy begins with a meticulous pre-surgical planning phase, involving close collaboration between the oral and maxillofacial surgeon and an orthodontist. This initial stage includes advanced imaging techniques such as 3D computed tomography (CT) scans and X-rays to create detailed models of the patient’s skull and jaw structure. These models allow surgeons to virtually simulate the procedure, plan precise bone movements, and fabricate custom surgical splints and guides to ensure accurate repositioning. Many patients also undergo orthodontic treatment with braces before surgery to align the teeth.
The surgery is performed under general anesthesia. Incisions are made inside the mouth to avoid visible external scars. Through these incisions, the surgeon accesses the bones of the upper jaw and midface. Specialized surgical saws are used to make precise bone cuts, carefully separating the targeted bone segments. Once mobilized, the bone segment is repositioned into its new, predetermined location.
After repositioning, the bones are stabilized using small, biocompatible titanium plates and screws, which permanently hold the segments in their new alignment. A surgical splint, fabricated during the planning phase, may be used to guide the correct bite and jaw position, and elastic bands may be placed on the teeth to maintain alignment. The incisions are then closed with dissolvable stitches.
Immediately after surgery, patients remain in the hospital for one to three days for monitoring. Significant facial swelling and bruising are expected, often peaking within 48 to 72 hours. Pain is controlled with prescribed medication, and patients begin with a liquid-only diet, gradually progressing to pureed or soft foods. Some patients may experience a blocked nose or blood-tinged discharge for a few days.
During the early recovery phase, spanning two to six weeks, patients continue a soft-food diet and manage residual swelling and bruising at home. Activity restrictions are in place, with strenuous exercise and contact sports generally avoided for four to eight weeks. Regular follow-up appointments with the surgeon and orthodontist monitor healing and ensure proper oral hygiene.
Long-term recovery involves a gradual return to normal function, with the ability to chew a regular diet restored over several weeks to months. While initial swelling subsides within a few weeks, some subtle swelling can persist for several months. Final bone healing and stability can take several months to a year, though the titanium plates provide immediate fixation. Orthodontic treatment often continues after surgery to refine the bite and achieve the final desired dental alignment.
Potential Risks and Complications
Le Fort osteotomy, like any major surgical procedure, carries potential risks. General surgical risks include infection, bleeding, and adverse reactions to general anesthesia.
Specific risks involve the intricate anatomy of the midface. One risk is nerve injury, particularly to the infraorbital nerve, which can lead to temporary or permanent numbness or altered sensation in the cheeks, upper lip, and teeth. This altered sensation, known as paresthesia, can occur due to stretching or direct damage to the nerve.
Another potential complication is relapse, where the repositioned jaw may partially shift back toward its original position. Rare but serious complications include malunion, where bones heal incorrectly, or non-union, where bones fail to heal completely, potentially requiring additional surgery.
There is also a risk of damage to adjacent anatomical structures, such as teeth or sinuses, during the bone cutting and repositioning phases. Excessive bleeding can occur during the procedure.