From the Guidelines
Lefort advancement orthognathic surgery is indicated for patients with midface hypoplasia or congenital micrognathia, as it can be a useful treatment option for these conditions. The indications for this surgery include:
- Midface deficiency, which can manifest as maxillary hypoplasia, a concave facial profile, and Class III malocclusion
- Maxillary retrusion relative to the mandible
- Insufficient projection of the cheekbones and infraorbital rims
- A negative overjet (where lower teeth are positioned in front of upper teeth)
- Anterior crossbite
- Functional issues such as difficulty with chewing or speech
- Obstructive sleep apnea when the maxillary deficiency contributes to airway obstruction, as supported by the study on non-cpap therapies in obstructive sleep apnoea 1 The surgery may also be recommended for patients with congenital conditions like cleft palate, Crouzon syndrome, or Apert syndrome, which often require LeFort advancement to correct associated midface deficiencies. According to the study, the efficiency of distraction advancement in OSAS treatment can be scored B in mandibular lengthening and C in midface advancement 1.
The procedure involves making osteotomies at specific levels of the maxilla (LeFort I, II, or III, depending on the extent of correction needed), followed by advancement and fixation with titanium plates and screws. Preoperative orthodontic treatment is typically required for 12-18 months to align the teeth properly, and patients should be skeletally mature (typically 14-16 years for females and 16-18 years for males) to minimize the risk of relapse due to continued growth. The study suggests that DOG (distraction osteogenesis) may be indicated in selected adults or adolescents as MMA (maxillomandibular advancement) is surgically difficult to achieve 1.
From the Research
Indications for Lefort Advancement Orthognathic Surgery
The indications for Lefort advancement orthognathic surgery include:
- Midface hypoplasia, which can be addressed through Le Fort III and Le Fort I procedures 2
- Class III malocclusion, where Le Fort III/I advancement can provide significant midface advancement 2
- Cleft lip and palate, where Le Fort I advancement can be used to correct maxillary hypoplasia 3, 4, 5
- Craniofacial anomalies, such as Crouzon syndrome, Apert syndrome, and Pfeiffer syndrome, which may require Le Fort III or monobloc advancement 2, 6
- Skeletal deformities, including those affecting the zygoma, orbits, nasal area, and forehead 2, 6
Patient Selection
Patient selection for Lefort advancement orthognathic surgery is crucial, and the decision to undergo surgery should be based on individual patient needs and characteristics. Factors to consider include:
- Severity of midface hypoplasia or malocclusion
- Presence of craniofacial anomalies or syndromes
- Age and overall health of the patient
- Ability to tolerate surgery and postoperative recovery
Surgical Techniques
Various surgical techniques can be used for Lefort advancement orthognathic surgery, including: