The Lefort procedure is a maxillofacial surgery of the upper jaw (maxilla). It repositions the maxilla, correcting facial and bite deformities. It aims to improve facial function and appearance by addressing skeletal discrepancies. The procedure adjusts the upper jaw’s position in multiple directions—forward, backward, upward, or downward—for harmonious facial alignment and a proper bite.
Understanding Different Lefort Procedures
Named after René Lefort, a French surgeon who classified facial fractures in the early 20th century, the Lefort procedure has three primary types: Lefort I, Lefort II, and Lefort III. Each addresses distinct midface anatomical areas. These procedures involve precise bone cuts to reposition specific facial structures.
Lefort I
Lefort I osteotomy is the most frequently performed, targeting the tooth-bearing upper jaw. A horizontal cut above the upper tooth roots separates the maxilla from the facial skeleton. Surgeons move the upper jaw in various directions—forward, backward, up, down, or rotated—for optimal alignment. This reshapes the face and improves the bite, addressing issues like a “gummy” smile or an overly long face.
Lefort II
Lefort II osteotomy is performed less often, moving a larger midface segment, including the upper jaw and nasal bones. It addresses deformities extending beyond the maxilla to the nose. This allows coordinated movement of the nose and upper jaw, beneficial for nasal lengthening or extensive midfacial correction.
Lefort III
Lefort III osteotomy is the most extensive, designed to advance the entire midface. It repositions multiple facial bones: eye sockets, nose, and upper jaw. It is reserved for more severe deformities, such as certain congenital conditions, to bring the entire midface forward for a more symmetrical appearance.
Conditions Addressed by Lefort Surgery
Lefort surgery corrects medical and aesthetic conditions from midface skeletal imbalances. It addresses severe malocclusion, where upper and lower teeth do not align, causing biting, chewing, and speaking difficulties. Repositioning the maxilla establishes a proper bite, improving oral function and preventing dental wear.
Lefort procedures also address facial asymmetry from uneven maxilla growth. Realigning the upper jaw restores facial balance and symmetry. For obstructive sleep apnea from a narrow or recessed maxilla, Lefort osteotomy widens the airway and alleviates breathing difficulties.
Congenital deformities like cleft lip and palate often require Lefort I surgery for stunted upper jaw growth and underbites. Craniosynostosis syndromes (Apert or Crouzon) often present with midfacial hypoplasia, necessitating Lefort II or Lefort III advancements to correct the underdeveloped midface and eye sockets. Significant facial trauma can also lead to deformities and malocclusion requiring a Lefort procedure to restore proper form and function.
The Surgical Journey
Extensive pre-operative planning ensures precise outcomes. Planning involves detailed clinical examinations, radiographic analysis, and advanced 3D imaging (cephalometric analysis). Virtual surgical planning (VSP) and model surgery simulate the procedure and determine exact maxilla movements.
Under general anesthesia, an anesthesiologist places a tube, typically through the nose, for breathing and vital sign monitoring. Incisions are made inside the mouth along the gum line to avoid visible external scars.
Through internal incisions, the surgeon accesses the maxilla, separating it from surrounding facial bones using specialized instruments. The maxilla is then mobilized and repositioned according to pre-planned specifications. Once in its new position, it is securely fixed with small, biocompatible titanium plates and screws. These provide stability during healing and remain in place indefinitely. After fixation, incisions are closed with dissolvable sutures, and patients are then monitored in a recovery area for initial healing, pain, and swelling control.
Post-Surgical Healing and Management
Following a Lefort procedure, patients experience an initial healing period of several weeks; full recovery extends over several months. Swelling and bruising are common, increasing for up to 72 hours post-surgery, mostly resolving within two weeks; some residual swelling may persist for months. Applying ice packs during the first 48 hours helps manage discomfort and swelling.
Dietary restrictions are key post-surgical management; patients adhere to a liquid or pureed diet for four to six weeks. They gradually transition to soft foods before resuming a regular diet. Meticulous oral hygiene is crucial to prevent infection and promote healing, involving gentle brushing and rinsing with prescribed mouthwashes.
Patients limit physical activity and avoid strenuous exercise or contact sports for four to six weeks post-surgery. Regular follow-up appointments with the surgeon monitor progress, jaw function, and healing. Orthodontic care, including rubber bands or continued braces, often resumes after initial healing to guide teeth into final alignment.