lefort I osteotomy


Osteotomy is a term that literally mean “bone cut.”  The Lefort I is a bone cut that separates the upper jaw from the face.  This is a very common type of osteotomy and is used to treat certain types of malocclusion (jaws not meeting together correctly). 

Most commonly, the Lefort I osteotomy is used to treat malocclusion in which the upper teeth are positioned behind the lower teeth (class III).  This sunken appearance of the midface can also make the lower jaw look too big.  This is a common condition in patients with cleft lip and palate.

Midface distraction is a technique that allows the midface to be moved forward slowly so the the body can lay down new bone behind the moving midface segment.  This helps to prevent relapse, or settling of the jaw back to where it started.  It also allows for movement of the jaw at a younger age then would be possible using other techniques.

The operation is performed by creating an incision inside the mouth, above the gums of the upper jaw.  The bone is carefully cut, loosening the palate and upper jaw from the skull base.  The incision is then closed with dissolving suture. 

The Lefort I segemnt (upper jaw) is then attached to a halo device either directly to the bone, or through an orthodontic device attached to the teeth.     The halo device is secured directly to the skull and allows for slow advancement of the jaw.

After the operation, the bones are allowed to start healing for about a week before movement is begun.  This allows the bone to start forming “callous” that can then be stretched or “distracted.”  This is the latent phase.

The distraction phase is the term for the actual movement of the jaw.  This is done very slowly (1mm per day) until the Lefort segment is in ideal position.  The distraction phase requires daily adjustments by the patient (or parent) over a period of 1-2 weeks.

Once the jaw is in ideal position, the adjustments are stopped and the segment is held in place until the new bone solidifies.  This process takes about 4-6 weeks.  Once this consolidation phase is complete, the halo device can be removed.

At this point, there is still some risk of relapse.  A nighttime “reverse headgear” device is used for another 6 weeks to help hold the Lefort I segment in place.

Lefort I distraction is a very effective technique for treating midface hypoplasia caused by cleft lip and palate.

Click here for more information on distraction.

About LeFort I Osteotomy


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