Midface Position after LeFort III Advancement

Prevention of halo pin complications in post-cranioplasty patients

“…In the 1960s, Tessier advocated a LeFort III osteotomy followed by direct midface advancement and rigid internal fixation with bone grafts as a treatment for these anomalies (Tessier, 1971). Advancement using this method, however, is limited and associated with considerable relapse of the mid-face (Kaban et al, 1984;Wolfe et al, 1993;Posnick and Dagys, 1994). The introduction of distraction osteogenesis elevated the hope of reducing the amount of relapse due to gradual distraction and production of new bone in the process.…”

Advancement of the midface, from conventional Le Fort III osteotomy to Le Fort III distraction: review of the literature

“…Pseudorelapse is observed in patients who were operated on in childhood and can be corrected successfully by a LF I procedure after skeletal maturity. Studies agree that the conventional LF III advancement procedure renders stable results with regard to the position of the skeletal midfacial segment, irrespective of the various cephalometrical landmarks and analyses used by the different authors 43,62,64 .…”

“…Considering the various studies available, the authors conclude that the standard LF III procedure provides a relatively stable postoperative position of the midface 22,27,43,44,62,64,73 . Relapse, when it occurred, could be attributed to inadequate postoperative fixation leading to backward rotation of the midface at the level of the orbits or to 'pseudorelapse', defined as relapse at the occlusal plane because of normal mandibular growth combined with decreased maxillary growth.…”

“…Several authors report some postsurgical sagittal growth of the midface, but do not differentiate between horizontal and vertical growth 19,22,43,50 . Some vertical growth is to be expected, whether the patients undergo surgery or not, owing to remodeling and appositional growth rather than to sutural growth 50 .…”

Additional orthognathic surgery following Le Fort III and monobloc advancement

“…Long-term studies report little or no relapse after both conventional Le Fort III osteotomy and Le Fort III DO, rendering both procedures to be stable 4,7,10,13,14 . DO in these cases is the treatment of choice to allow for these large advances.…”