Modified Le Fort I osteotomy techniques for vertical maxillary excess: a comparative systematic review

Importance: Vertical maxillary excess (VME) is a common dentofacial deformity that causes downward growth of the maxilla, leading to an elongated lower face, anterior open bite, and excessive gingival display. Although conventional Le Fort I osteotomy remains the gold standard for correcting vertical maxillary excess, it is associated with certain risks, including possible injury to the descending palatine artery (DPA). To improve surgical safety and treatment predictability, several modified osteotomy techniques have been introduced.

To systematically review and compare the clinical effectiveness, postoperative stability and safety of modified Le Fort I osteotomy techniques in treating VME.

Data Sources: A systematic search was conducted using PubMed, Medline, Google Scholar, and Web of Science databases for studies published between 2016 and 2024. The review protocol was registered with PROSPERO (CRD42025616635).

Studies involving adults with vertical maxillary excess (VME) were included. Eligible studies evaluated modified Le Fort I osteotomy techniques-specifically conventional horseshoe, modified horseshoe, unilateral horseshoe, pyramidal, or U-shaped osteotomies-in patients undergoing orthognathic surgery. A total of 10 studies comprising 117 patients met the inclusion criteria.

Data extraction and synthesis were performed systematically to obtain information regarding surgical techniques, intraoperative and postoperative complications, maxillary repositioning accuracy, and long-term stability outcomes. Given the methodological and clinical heterogeneity among the included studies, a qualitative synthesis of the findings was undertaken.

Primary outcome measures included successful maxillary repositioning, intraoperative or postoperative complications (particularly vascular injuries), and skeletal stability over at least one year.

Results: The electronic search identified 1,190 articles, of which 10 studies met the inclusion criteria. All reviewed modified Le Fort I techniques achieved intended repositioning without major complications. Notably, there were no significant vascular injuries, and skeletal stability was maintained for at least 12 months.

Conclusion and Relevance: Modified Le Fort I osteotomies represent safe and effective alternatives to traditional methods, reducing risks while ensuring stable outcomes. Tailoring techniques to individual patient needs is crucial for optimizing aesthetic and functional results in VME management, ultimately improving patient satisfaction and quality of life. PROSPERO (CRD42025616635).