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 13 to 15

13. Fixation (fig:13)
Identify any tear in the nasal mucosa and suture them with vicryl 3.0. Appropriate holes are made for fixation of the maxilla in the "new" position. Irrigate the sinus with copious saline and betadine solution. Place surgicel or gelfoam to prevent postop bleeding. Recheck the occlusion and position of the maxilla and immobilize it with 26 gauge wire. Alternatively bone plates and screws maybe used. The intermaxillary fixation is removed after immobilization of the maxilla.
Fixation (fig:13)
14. Cinch suture (fig:14)
Since a part of the lateral wall of the nasal cavity is removed there is a possibility of the widening of the alar base. This can be prevented by alar cinch suture using proline 2.0.
Cinch suture (fig:14)
15. Mucosal suture (fig:15)
Mucosal incision is closed with vicryl 3.0. V-Y closure of the lip is done to prevent the shortening of the lip.

Infiltrate the local area with sensocaine 0.5% for pain relief and homeostasis. Pressure dressing with dynaplast is given extraorally to control swelling and hematoma formation. After reversal of anesthesia, maintain a lateral position to prevent aspiration of any discharge and completely monitored in the ICU for 24 hours.

Mucosal suture (fig:15)

If there is bimaxillary skeletal protrusion with proclination of lower teeth then subapical osteotomy is combined with Le-fort I and AMO. In majority of the cases a genioplasty augmentation may have to be done to correct the deficient chin and give a pleasant definition to the Labiomental fold.

Postsurgical Orthodontia can be commenced after 4 - 6 weeks. A good teamwork is necessary between the Orthodontist and the Maxillofacial Surgeon. Box elastics maybe used to achieve maximum intercuspation. Evidence of skeletal relapse should be closely monitored and remedial measures are to be taken if any relapse is observed.

Lefort I can be used for augmentation of deficient maxilla, by skipping step 10 (Anterior Maxillary Osteotomy) and augmenting the maxilla forward.

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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.

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updated Aug2002.