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Le Fort Osteotomy: Types, Procedure and Outcomes

Le Fort osteotomy is an oral and maxillofacial surgical procedure to correct misalignments of the upper jaw. Depending on the type, different bone levels of the midface are cut and repositioned.

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Things worth knowing about "Le Fort Osteotomy"

Le Fort osteotomy is an oral and maxillofacial surgical procedure to correct misalignments of the upper jaw. Depending on the type, different bone levels of the midface are cut and repositioned.

What is Le Fort Osteotomy?

Le Fort osteotomy is a surgical procedure in oral and maxillofacial surgery in which bones of the upper jaw and midface are cut and repositioned into a functionally and aesthetically correct alignment. The procedure is named after the French surgeon René Le Fort, who at the beginning of the 20th century described typical fracture patterns of the facial skeleton. Today, the technique is primarily used to treat congenital or acquired jaw deformities.

Types of Le Fort Osteotomy

Three classic types are distinguished, differing in the level and extent of bone separation:

Le Fort I Osteotomy

In the Le Fort I osteotomy, the entire dental arch of the upper jaw is cut horizontally above the tooth roots. This allows the upper jaw to be moved forward, backward, upward, or downward, as well as tilted or rotated. This is the most frequently performed type and is especially suitable for correcting vertical and sagittal misalignments of the upper jaw.

Le Fort II Osteotomy

The Le Fort II osteotomy involves a larger area of bone: the cut runs across the nasal bridge and the margins of the cheekbones, mobilising a pyramid-shaped segment of the midface. This procedure is used for pronounced midface hypoplasia, meaning when the entire middle third of the face is underdeveloped.

Le Fort III Osteotomy

The Le Fort III osteotomy is the most extensive procedure: here, the entire midface including the zygomatic bones is separated from the skull base and advanced forward. It is frequently applied in patients with severe craniofacial syndromes such as Crouzon syndrome or Apert syndrome.

Indications

Le Fort osteotomy is used for various conditions and jaw deformities:

Prognathism: upper jaw positioned too far posteriorly
Retrognathia: backward displacement of the upper jaw
Open bite (anterior or posterior)
Midface hypoplasia in craniofacial syndromes
Asymmetries of the upper jaw
Severe obstructive sleep apnea in combination with lower jaw advancement

Preparation and Planning

Before the procedure, extensive orthodontic pre-treatment is carried out, typically lasting one to three years. Surgical planning includes:

Cephalometric X-ray analysis (lateral cephalogram)
Digital 3D planning and virtual surgical planning (VSP)
Fabrication of occlusal splints for intraoperative positioning
Dental model analysis and cone beam computed tomography (CBCT)

Surgical Procedure

The procedure is performed under general anaesthesia. Surgical access is achieved through incisions inside the oral cavity, leaving no visible external scars. After the bone is cut using specialised saws and osteotomes, the bone segment is moved into the planned new position and stably fixed with titanium plates and screws. The duration of surgery ranges from two to six hours depending on complexity.

Aftercare and Healing

After surgery, the patient typically remains hospitalised for three to five days. The postoperative phase includes:

Swelling and bruising of the face, significantly subsiding after two to four weeks
Soft diet for six to eight weeks
Orthodontic follow-up treatment for fine adjustment of the bite
Regular check-up appointments for at least one year
Complete bony healing within approximately three to six months

Risks and Complications

As with any surgical intervention, possible risks include:

Numbness of the upper lip, nose, or teeth due to temporary or permanent nerve irritation
Postoperative bleeding or infection
Relapse (return to the original jaw position)
Asymmetry of the surgical result
Changes in nasal shape
In rare cases: impaired blood supply to the mobilised bone segment

Results and Prognosis

Le Fort osteotomy is one of the well-established and successful procedures in orthognathic surgery. With correct indication, careful planning, and orthodontic support, functional and aesthetic outcomes are very good in the majority of cases. Patients frequently report a significant improvement in chewing function, speech, and overall quality of life.

References

Proffit, W. R.; White, R. P.; Sarver, D. M.: Contemporary Treatment of Dentofacial Deformity. Mosby, 2003.
Hausamen, J.-E.; Machtens, E.; Reuther, J. F.: Oral and Maxillofacial Surgery. Springer, 2012.
Obwegeser, H. L.: Mandibular Growth Anomalies. Springer Verlag, 2001.

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