Superior repositioning of the maxilla by a Le Fort I osteotomy: A review of 26 patients (original) (raw)
Related papers
Journal of Cranio-Maxillofacial Surgery, 1996
SUMMAR Y. In 25 patients with vertical maxillary deficiency, selected from a group of 410 Le Fort I osteotomies, the anterior part of the maxilla was repositioned inferiorly. Four groups could be distinguished. A group (n = 6) with downgrafting of the maxilla alone, fixed with wire osteosynthesis, a group (n-6) treated with Le Fort I and sagittal split osteotomy with a wire-fixed maxilla, a group (n = 8) with a Le Fort I and vertical ramus osteotomy where the maxilla was fixed with wire and a group (n = 5) treated by Le Fort I and vertical ramus osteotomy in which the maxilla had been fixed with miniplate osteosynthesis. In the group of single maxilla repositioning and in the bimaxillary group with a plate-fixed maxilla, the range of relapse was-0.3 mm to + 1.0 mm (mean + 0.4 mm) and 0 mm to + 1.0 mm (mean + 0.5 mm) respectively, which was not correlated to the distance of inferior repositioning. The bimaxillary cases, in which the maxilla had wire osteosynthesis, showed postoperative relapse ranging from-1. 4 mm to + 3.4 nun (mean + 1.3 mm) (sagittal split osteotomy) and-1. 1 mm to + 3.7 mm (mean + 1.2 mm) (vertical ramus osteotomy). In these cases the outcome of surgical intervention appeared completely unpredictable. If these figures are presented as percentages as is done in the literature in the majority of publications, a misleading impression appears. Likewise information about operation technique, fixation methods and linear measurements of movement and relapse (instead of percentages) are essential in comparing different studies.
Surgical-orthodontic correction of vertical maxillary excess
American journal of orthodontics, 1978
Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontist's desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appear...
Orthognathic surgery effects on maxillary growth in patients with vertical maxillary excess
American Journal of Orthodontics and Dentofacial Orthopedics, 1997
This study assesses the effects of superior repositioning of the maxilla by LeFort I osteotomy on adolescent maxillary growth. A total of 48 patients, 23 who were stabilized with rigid fixation (RF) and 25 stabilized with wire fixation (WF), were compared with closely matched unoperated controls. Comparisons were made for the presurgical intervals (2.3 years for RF and 1.3 years for WF groups) and postsurgical intervals (1.9 years for RF and 2.3 years for the WF groups). Lateral cephatograms were evaluated to describe the presurgical and postsurgical spatial changes of the maxilla. During the presurgical interval, there were no significant differences in vertical or horizontal maxillary growth between the WF group and their controls. Although vertical growth changes were similar, the RF group showed slightly more than expected posterior movement of the upper incisor during the presurgical interval. During surgery, the maxilla was advanced approximately 2 mm and impacted approximately 2 mm. After surgery, there were no statistically significant differences in vertical maxillary growth between the two surgical and control groups. Horizontally, the RF group showed maxillary stability, whereas the WF groups showed posterior movement. It is concluded that multiple piece LeFort I osteotomy has little or no effect on vertical maxillary growth; rigid fixation provides superior long-term anteroposterior stability compared with wire fixation. (Am J Orthod
International Journal of Oral and Maxillofacial Surgery, 1997
A sample of 267 patients with maxillary hyperplasia, a Class I or Class II/I occlusion and anterior vertical open bites, collected from three different institutions, was analysed regarding stability after surgical corrections. Skeletal and dento-alveolar stability of the maxilla, and positional changes of the mandible and of the incisors were evaluated. All patients underwent Le Fort I intrusion osteotomies and in 92 patients segmentation of the maxillae was performed. An additional bilateral sagittal split advancement osteotomy was performed in 123 patients. Intraosseous wire fixation was used in 153 patients and rigid internal fixation in 114 patients. Cephalometric radiographs were collected before orthodontic treatment, before surgery, immediately after surgery, one year postoperatively and at the latest follow up. The mean follow up was 69 months (range 20-210 months). It can be concluded that patients with anterior open bites, treated with a Le Fort I osteotomy in one-piece or in multi-segments, with or without bilateral sagittal split osteotomy, exhibited good skeletal stability of the maxilla. Rigid internal fixation produced the best maxillary and mandibular stability. The mean overbite at the longest follow up was 1.24 mm and a lack of overlap between opposing incisors was present in 19%. The overbite did not differ significantly between the different treatment procedures, probably due to compensatory movements of the mandibular and maxillary incisors.
Journal of Oral and Maxillofacial Surgery, 1998
This study compared single maxillary surgery and a two-jaw procedure in patients who underwent one-piece Le Fort I advancement without bone grafting. Patients and Methods: Fifty-three patients had Le Fort I osteotomy performed using a standard technique. Twenty-two patients had maxillary surgery alone, and 3 1 patients additionally had a bilateral sagittal split ramus osteotomy performed. Both rigid and nonrigid fixation were used. The postoperative movement of the maxilla was investigated, comparing cephalograms taken preoperatively, 2 to 3 days postoperatively, and at least 6 months postoperatively. A computer program was used to superimpose the three radiographs. Results: No difference in postoperative stability was found when the two surgical procedures were compared, and no correlation between magnitude of advancement and degree of relapse could be identified (P > .05). Nonrigid fixation in patients receiving only maxillary surgery resulted in greater postoperative forward movement of the maxilla (P = .022). Conclusion: This study indicates that postoperative stability of the maxilla in a two-jaw procedure is equivalent to that of single maxillary surgery. Nonrigid fixation in single maxillary surgery reduces the need for postoperative orthodontics. The Le Fort I osteotomy, introduced by Obwegeser' in the 1960s, and first evaluated by Willmar in 1974, is a commonly used operation in the management of midfacial deformities. In combination with the bilateral sagittal split ramus osteotomy,s it provides the most useful method for improving facial contour, eliminating asymmetries, and establishing good occlusion. Stability of the Le Fort I osteotomy is considered essential for a good result. Several parameters such as soft tissue traction,*6 amount of displacement,4,5,7,8 bone grafting,@ presence of clefts,7J0 type of lixa