Segmental Lefort I Osteotomy: An Upgraded Approach in Orthognatic Surgery for Midface Deformities

Abstract

The treatment of dentofacial deformity often calls for a combined orthodontic and surgical approach to obtain satisfactory functional and aesthetic results with long term stability. The most frequent surgical procedure performed for correction of defects of maxilla is Lefort I osteotomy, both in its original form and with modern variations. Lefort I, specifically, is used to adjust the position of maxilla and maxillary teeth in three dimensions, either alone or in concert with other interventions to achieve these goals. Segmental Lefort I osteotomy , a modification of classical Lefort I osteotomy provides coordination of the premaxilla with the posterior segments while simultaneously enabling an improvement in transverse dimension. It is recommended for arduous anomalies like anterior open bite, vertical maxillary excess, transverse maxillary defeciencies. 

We present 2 cases: a case of vertical maxillary excess with skeletal class II deformity in a 20 year female and a case of anterior open bite with skeletal class I relation in a 36 year female. In both cases, segmental (two-piece) Lefort I with BSSRO were performed with additional genioplasty in former case. Through the combined orthodontic-surgical intervention pronounced skeletal, dental and occlusal improvement were achieved.

The main purpose of this presentation is to highlight major advantages of segmental Lefort I osteotomy: single surgical intervention, reduced period of covalescence, psychological impact and treatment duration.