Technical Modifications for Intraoral Quadrangular Le Fort II Osteotomy.

Area of Science:

• Oral and Maxillofacial Surgery
• Plastic Surgery
• Orthognathic Surgery

Background:

• Midfacial deficiency requires surgical correction for functional and esthetic improvement.
• The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) is a recognized method for addressing midfacial hypoplasia.
• Traditional IQLFIIO techniques may involve risks in the orbital and paranasal regions.

Purpose of the Study:

• To present surgical modifications of the IQLFIIO technique.
• To evaluate the safety and efficacy of using piezosurgery and modified fixation methods.
• To reduce complications associated with traditional IQLFIIO.

Main Methods:

• Modified IQLFIIO involving inferior orbital rim osteotomy with piezosurgical instruments.
• Osteosynthesis exclusively at the zygomatic buttress using two L-shaped miniplates.
• Advancement step camouflage with autologous bone chips and fibrin glue.

Main Results:

• Piezosurgery enabled safe bone cutting without chisels in the orbital region for all 13 patients.
• No atypical fractures or infraorbital nerve anesthesia were observed.
• Osseous healing at the infraorbital advancement step was confirmed by 3D scans, with decreasing midfacial hypesthesia over time.

Conclusions:

• The modified IQLFIIO technique using piezosurgery is safe and effective for treating midfacial deficiency.
• Minimally invasive orbital bone cutting and modified fixation provide stable results.
• Further research will investigate soft and hard tissue changes following IQLFIIO advancement.