Modified Le Fort III osteotomy: A simple solution to severe midfacial hypoplasia

Area of Science:

• Craniofacial surgery
• Orthognathic surgery
• Distraction osteogenesis

Background:

• Severe midfacial hypoplasia presents complex challenges in surgical correction.
• Traditional Le Fort osteotomies and distraction osteogenesis have distinct advantages and disadvantages.
• Minimally invasive approaches are sought to improve patient outcomes.

Purpose of the Study:

• To evaluate a modified Le Fort III osteotomy with distraction osteogenesis (DO) in patients with severe midfacial hypoplasia.
• To assess the efficacy and safety of a minimally invasive surgical approach for midfacial advancement.

Main Methods:

• A cohort of patients with severe midfacial hypoplasia underwent a modified Le Fort III osteotomy without the nasofrontal component.
• A transconjunctival and trans-oral approach was utilized.
• External or internal distractors were applied, and outcomes including distraction amount, surgical time, blood loss, and complications were analyzed.

Main Results:

• Seven patients (3 with Crouzon syndrome, 2 with Pfeiffer syndrome, 1 cleft lip/palate sequel, 1 non-syndromic Class III) were treated.
• Average advancement was 14.7 mm, achieving stable occlusion and positive overbite/overjet without relapse.
• Average surgery time was 2.78 hours with 240 ml blood loss; 4 patients required secondary rhinoplasty.

Conclusions:

• The modified Le Fort III osteotomy with DO is a low-morbidity, efficient technique for severe midfacial hypoplasia.
• It provides stable skeletal correction, avoids grafts, and preserves nasofrontal parameters.
• The technique demonstrates versatility for asymmetrical cases and allows for staged nasal correction if needed.