What are the differences between L-shaped plates and Lindorf plates in Le Fort 1 (Le Fort I, a type of orthognathic surgery) osteotomy?

L-Shaped Plates vs Lindorf Plates in Le Fort I Osteotomy

Direct Answer

For Le Fort I osteotomy fixation, use patient-specific plates when available, as they demonstrate superior skeletal stability with significantly less relapse compared to stock plates, particularly for advancements greater than 10mm. 1 When patient-specific plates are not available, standard L-shaped miniplates provide reliable three-dimensional rigid fixation with predictable outcomes and low relapse rates. 2

Understanding the Plate Options

Patient-Specific Plates (Modern Standard)

• Patient-specific implants (PSIs) are custom-manufactured plates designed from preoperative 3D imaging that provide wafer-free fixation of the maxillary segment. 3
• In cleft lip and palate patients, patient-specific plates showed dramatically less relapse at 1 year: only 4.3% had ≥1mm horizontal change versus 50.0% with stock plates (P < 0.001), and only 4.3% had ≥1mm vertical change versus 65.0% with stock plates (P < 0.001). 1
• For large advancements (>10mm horizontal movement), patient-specific plates demonstrated mean relapse of only 0.105 ± 0.317 mm compared to 1.888 ± 1.125 mm with stock plates (P = 0.003). 1

Standard L-Shaped Miniplates (Traditional Approach)

• L-shaped miniplates provide rigid, internal, three-dimensional fixation that has been the traditional standard for Le Fort I osteotomies. 2
• These plates allow marked reduction in intermaxillary fixation duration, requiring only light training elastics postoperatively, which eliminates immediate postoperative airway problems. 2
• Six-month follow-up data indicates low potential for osseous relapse regardless of maxillary movement direction when compared to wire osteosynthesis. 2

Note on "Lindorf Plates"

The term "Lindorf plates" does not appear in the current orthognathic surgery literature. You may be referring to a specific manufacturer's plate design or a regional terminology. The standard nomenclature uses "L-shaped plates," "miniplates," or "patient-specific implants."

Clinical Decision Algorithm

When to Use Patient-Specific Plates:

• Large advancements (>10mm) where stability is critical 1
• Cleft lip and palate patients who have higher relapse risk 1
• Complex multi-plane movements requiring precise positioning 3
• When wafer-free fixation is desired for improved surgical workflow 3

When Standard L-Shaped Miniplates Are Appropriate:

• Routine Le Fort I osteotomies with moderate movements 2
• When patient-specific plates are not available or cost-prohibitive 3
• Straightforward advancements, intrusions, lengthenings, or retrusions 2

Comparative Stability Data:

While one study found no statistically significant differences in postoperative skeletal stability between PSI and miniplate fixation in general orthognathic patients 3, the more recent 2025 study in cleft patients demonstrated clear superiority of patient-specific plates 1. This discrepancy likely reflects differences in patient populations and measurement techniques, with the cleft population representing a more challenging cohort where the benefits of PSI become more apparent. 1, 3

Technical Considerations

Advantages of Rigid Plate Fixation (Both Types):

• Eliminates need for prolonged intermaxillary fixation 2
• Provides immediate three-dimensional skeletal stability 2
• Allows early functional rehabilitation 2
• Reduces postoperative airway complications 2

Critical Pitfall to Avoid:

The major disadvantage of rigid plate fixation is decreased ability of postoperative orthodontics to correct residual skeletal occlusal disharmony. 2 Therefore, meticulous preoperative planning and precise operative technique are absolutely critical—you cannot rely on postoperative orthodontics to "fix" skeletal positioning errors as you could with wire osteosynthesis. 2

Surgical Technique Requirements:

• Close attention to preoperative virtual surgical planning is mandatory when using rigid fixation 2
• Ensure accurate three-dimensional positioning before final plate fixation 2
• For patient-specific plates, use the provided cutting and drill guides to ensure proper positioning 3

Alternative Considerations

For patients with combined maxillary-zygomatic deficiency, a modified Le Fort I (maxillary-zygomatic) osteotomy may be considered, which virtually eliminates the need for simultaneous bone grafting or alloplastic implants while providing predictable esthetic results and excellent skeletal stability. 4 However, this is a different surgical approach rather than a different fixation method. 4