Subcranial procedures in craniofacial surgery: the Le Fort III osteotomy

The esthetic stigmata and functional impairments associated with craniofacial deformities have long challenged surgeons in the management of deficiencies of the middle third of the face. By their very nature, craniofacial anomalies are repetitive patterns of deformity that affect the different functional and esthetic subunits of the facial hard and soft tissues. Although numerous procedures exist for the management of the various craniofacial malformations in the middle third of the facial skeleton, only the subcranial Le Fort III osteotomy addresses all of the functional and esthetic components of total midface deficiency, when considering an extracranial approach for surgical correction of the deformity. This article discusses craniofacial dysostosis and total midface deficiency and the techniques and care involved with both.