Le-Fort I and Anterior Maxillary Osteotomy

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Surgical Procedure:	Steps 1 to 4
1. General and Local Anesthesia (Fig:1) Preformed maxillofacial endotracheal anesthic tubes are excellent for giving intranasal general anesthesia for maxillofacial surgeries. It neither kinks nor injure the nasal tissues due to it’s favorable contour. Bleeding at the surgical site can be greatly controlled with an hypotensive anesthesia. This also reduces swelling postop. Infiltrate the local area of dissection with 2% lignocaine containing adrenaline 1:200,000.
2. Extractions and Palatal subperiosteal tunneling (Fig:2) Premolars and usually the last molars are extracted. The palatal mucosa is tunneled using a periosteal elevator. This procedure prevents tearing of the palatal tissues while doing anterior maxillary osteotomy.
3. Mucoperiosteal incision (Fig:3) Make an incision in the buccal sulcus using a no:15 surgical blade from 1st molar to 1st molar area about 6mm above the gingival margin. This will help in suturing later and will not compromise on blood supply.
4. Subperiosteal dissection (Fig:4) Expose the lateral aspect of nasal cavity and carefully elevate the nasal mucosa without perforating it. Posteriorly, dissect around the tuberosity and tunnel up to the pterygoid.

Prof. (Dr) Varghese Mani, Oral and Maxillofacial Surgeon
Member Dental Council of India
Past President Oral and Maxillofacial Surgeons of India.
Consultant
Mani Specialty Clinic, MG Road, Trichur, Kerala 680004, India. Phone -- 0091-0487-385996
Trichur Institute of Head and Neck Surgery (TIHANS), Shornur Road, Trichur.

updated Aug2002.