Surgical Procedure:Le-Fort I & Anterior Maxillary Osteotomy
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Le-Fort I and Anterior Maxillary Osteotomy

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Surgical Procedure:

Steps 9 to 12

9. Maxillary downfracture and mobilization (fig:9)
By using thumb pressure on the anterior aspect, the maxilla is downfractured. Revise the osteotomies if there is difficulty in down fracturing. Mobilse the maxilla with the help of the pterygoid osteotome. Make sure the maxilla is completely detached and mobile.
Maxillary downfracture and mobilization (fig:9)

10. Anterior maxillary osteotomy (fig:10)
Anterior maxillary osteotomy is done at the premolar region with a micromotor and 590 surgical bur. Care should be taken not to tear the palatal mucosa. Place the bulb of your forefinger to feel for the cut.
Anterior maxillary osteotomy (fig:10)
11. Septoplasty (fig:11)
The nasal septal cartilage is trimmed with scissors to prevent a deviated septum when the maxilla is repositioned superiorly. Sometimes turbinectomy may be required to prevent interference from the inferior turbinate.
 Septoplasty (fig:11)
12. Refining the osteotomies (fig:12)
Trimming of the posterior wall and the palatal bone are done for final adjustments using a bone nibbler. All bony interferences should be removed for accurate repositioning of the maxilla. Stabilize the anterior maxilla with 28 gauge wires. The measurements made during pre-surgical analysis is checked and reviewed. Achieve the planned lip position and occlusion. Temporary intermaxillary fixation is done to maintain the occlusion.
Refining the osteotomies (fig:12)


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

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