The LeFort procedure is a specialized type of corrective jaw surgery, also known as orthognathic surgery, which focuses on repositioning the upper jaw, or maxilla. The primary goal of this procedure is to correct significant skeletal discrepancies that affect the alignment of the bite, a condition known as malocclusion. By surgically moving the maxilla, surgeons can achieve functional improvements in chewing, speaking, and breathing, while simultaneously enhancing the balance and harmony of the facial structure. The surgery is defined by a controlled fracture, or osteotomy, of the facial bones, named after the French surgeon René Le Fort.
The Three Types of Lefort Surgery (Lefort I, II, and III)
The LeFort classification system defines the level of the osteotomy within the midface, determining the extent of the facial skeleton that is repositioned. The LeFort I osteotomy is the most frequently performed variation, involving a horizontal cut across the maxilla just above the dental roots and the floor of the nasal cavity. This technique allows the entire tooth-bearing portion of the upper jaw to be moved forward, backward, upward, or downward to correct common issues like maxillary hypoplasia or an open bite.
The LeFort II osteotomy is a more extensive pyramidal cut that addresses deformities higher up in the midface, including the nasal bones. The osteotomy extends from the nasal bridge down through the inner orbital rim and across the zygomaticomaxillary buttresses. This approach is typically chosen for patients with nasomaxillary hypoplasia, where the central face is retruded, often seen in specific craniofacial syndromes. Moving this segment forward helps correct the nasal profile and further improves the alignment of the dental arch.
The LeFort III osteotomy is the most comprehensive procedure. The cuts extend high across the orbital floor, through the lateral orbital walls, and across the zygomatic arches, effectively mobilizing the entire midface from the cheekbones to the upper jaw. This complex operation is indicated for patients with severe syndromic conditions, such as Crouzon or Apert syndromes, where the entire facial structure below the forehead needs to be advanced. Advancing this large segment helps to alleviate severe problems like shallow orbits and obstructive sleep apnea.
Inside the Operating Room: How Maxillary Repositioning Occurs
The LeFort procedure is performed under general anesthesia, and the surgical team typically accesses the bone entirely through internal incisions, avoiding external facial scars. A long incision is made inside the mouth in the upper gum line, which allows the surgeon to expose the underlying maxilla.
Specialized surgical tools are used to carefully create the planned osteotomy line in the bone. For a LeFort I, the bone is cut horizontally, and the maxilla is then separated from the skull base using controlled force. Once the segment is fully mobilized, the surgeon manually repositions the maxilla into its new, pre-planned alignment with the aid of a surgical splint, or wafer, that fits over the teeth.
The maxilla is secured permanently in its final position using small, biocompatible titanium plates and screws. The surgeon then checks the final bite alignment before closing the internal incisions with dissolvable sutures. This fixation is designed to hold the bone fragments rigidly while the body’s natural healing process integrates the repositioned segment.
The Healing Journey: Recovery and Long-Term Adjustments
Patients typically remain in the hospital for one to three days following the surgery. Significant facial swelling and bruising are expected, usually peaking within the first two to three days after the procedure. Applying cold compresses and sleeping with the head elevated above the heart helps to manage this initial swelling.
A major adjustment for recovery is a strict dietary change. Patients must remain on a liquid or pureed diet for approximately four to six weeks following the operation. Transitioning back to solid food is gradual, with most patients requiring about three months before they can chew comfortably and with full force.
Temporary numbness, or paresthesia, is a common consequence of the surgery due to the proximity of the bone cuts to sensory nerves. Following an upper jaw procedure, this altered sensation is most often experienced in the upper lip, gums, and palate. While sensation may feel blunted or altered initially, the majority of patients experience significant improvement or full return of sensation over a period of several months as the nerves regenerate.
Most people are able to return to work or school within two to four weeks. The bone stabilization process takes several months, and the final alignment of the bite is often fine-tuned with orthodontic elastics following the initial surgical recovery.