Simultaneous Midface Advancement and Orthognathic Surgery: A Powerful Technique for Managing Midface Hypoplasia and Malocclusion

Abstract

Background: Midface hypoplasia dramatically affects the normative facial cascade. Simultaneous Le Fort III and Le Fort I procedures (Le Fort III/I) provide a powerful tool for achieving significant midface advancement. This study presents the authors’ approach for addressing midface hypoplasia in the setting of class III malocclusion using Le Fort III/I advancement. Methods: This was an institutional review board–approved retrospective review of patients who underwent Le Fort III/I advancement at the authors’ institution from 2009 to 2019. Demographic, surgical, and postoperative data were recorded. The authors’ operative technique and surgical pearls are described. Results: Twenty-five patients met inclusion criteria, 15 male patients (60 percent) and 10 female patients (40 percent). Patient age ranged from 14.9 to 21.6 years. Diagnoses included Crouzon syndrome, nonsyndromic developmental skeletal dysplasia, cleft lip/palate, Klippel-Feil syndrome, Apert syndrome, Van den Ende-Gupta syndrome, and Pfeiffer syndrome. Le Fort III advancements averaged 6.18 ± 1.38 mm and Le Fort I advancements averaged 6.70 ± 2.48 mm. Thirteen patients underwent simultaneous bilateral sagittal split osteotomy with average movement of 5.85 ± 1.21 mm. Average follow-up was 1.3 ± 1.0 years. One patient experienced intraoperative cerebrospinal fluid leak that resolved with expectant management. Three patients experienced major complications (12 percent) postoperatively necessitating repeated orthognathic operations. Ten patients experienced minor complications (40 percent). Average length of stay was 10 days, with all patients achieving improvement of their facial profile. Conclusions: The authors’ experience reaffirms the relative safety of simultaneous Le Fort III/I advancement. This technique should be considered in select patients with global midface retrusion and class III malocclusion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Vertical Line through the Glabella Point as the Optimized Reference Line of Ideal Maxillary Sagittal Position During Orthognathic Surgery Planning for Chinese Adult Skeletal Malocclusion Patients: A Case-Control Study

“…In contrast, the ideal reference position of the maxilla in the vertical and horizontal directions has relatively speci c targets, such as the symmetry, angle of the occlusion plane, deviation from the midline, and distance from the lip. [23][24][25] Investigators have made great efforts to nd ideal prediction methods for the ideal maxilla position in the sagittal direction. [26][27][28] The maxillary incisor is a critical landmark of the maxilla position.…”

Reply: Simultaneous Midface Advancement and Orthognathic Surgery: A Powerful Technique for Managing Midface Hypoplasia and Malocclusion

“…We appreciate Dr. Zeng and Dr. Jin for their interest in our article, entitled “Simultaneous Midface Advancement and Orthognathic Surgery: A Powerful Technique for managing Midface Hypoplasia and Malocclusion.” 1 We also appreciate the comment by Chou et al 2 published in the June 2021 issue of the Journal . We would like to respond to their letters to better clarify the benefits of a combined Le Fort III and Le Fort I (Le Fort III/I) in specific patients.…”

Simultaneous Midface Advancement and Orthognathic Surgery: A Powerful Technique for Managing Midface Hypoplasia and Malocclusion

“…The authors described that 40 percent of included patients had isolated cleft lip and/or palate. 1 We would have appreciated it if the authors had shared further information on how to select patients with cleft…”

“…Was the midface hypoplasia and class III malocclusion further combined with asymmetry at the orbital rim, midface, and mandible levels? In addition to advancing the lateral orbit, orbital rim, and entire nose, 1 was the yaw rotation of the Le Fort III segment required to address any asymmetric deformity?…”