Open Access
Subscription Access
Role of Le Fort I Osteotomy in Orthosurgical Management of Maxillary Deformities in North Indian Population
Background: Le Fort I osteotomy is one of the most commonly performed procedure, either alone or in conjunction with other orthognathic procedures for maxillary deformities.
Objective: The present prospective study pertains to definite diagnosis, orthosurgical planning with cephalometric predictions of dento-osseus deformities of maxilla and their correction by LeFort I osteotomy.
Material and Methods: Fourteen patients with skeletal deformity along with malocclusion which was too severe to be corrected orthodontically alone were selected. Parameters were selected on the basis of clinical findings, cephalometrically hard and soft tissue landmarks [COGS (Burstone and Legan) and Steiners analysis]. Parameters were observed and compared preoperatively prediction values, postoperatively and on follow-up.
Results: There were obvious improvement in various linear and angular readings of hard and soft tissues.In linear measurements,NANS ⊥ HP decreased from 57.62 ± 3.3 to 52.4 ± 2.9; ANS-Gn ⊥ HP decreased from 75.8 ± 8.1 to 69.3 ± 6.1; NA || HP reduced by approximately 5mm; N-Pg || HP decreased from -12.07 ± 9.6 to -3.78 ± 8.8 and PNS-N ⊥ HP decreased from 55.28 ± 5.08 to 58.07 ± 4.4. On analysis of angular hard tissue measurements, N-A-Pg angle decreased from 5.14 ± 5.75 to 4.17 ± 2.73 (superior repositioning of maxilla) and increased from 3.0 ± 1.4 to 4.5 ± 0.7 (inferior repositioning of maxilla);MP-HP angle, Ar-Go-Gn angle decreased following superior repositioning and increased following inferior repositioning of maxilla and SNA angle decreased from mean 80.8 to 79.5.
Conclusion: LeFort I osteotomy is really a workhouse of orthognathic surgery in which maxilla can be mobilized in vertical and saggital planes to correct various dento-osseous deformities.
Keywords
- Langenbeck B von. Die Uranoplastik. Arch Klin Chir 1861;2:252.
- Cheever DW. Nasopharyngeal polypus attached to the basilar process of the occipital and body of the sphenoid bone successfully removed by section displacement and subsequent replacement and reunion of the superior maxillary bone. Boston Med Surg Journal 1867;8:162.
- Sailer HF, Haers PE, Gratz KW. The Le Fort I osteotomy as surgical approach for removal of tumours of the midface. J Cranio Maxillofac Surg 1999;27:1.
- Moloney F, Worthington P. The origin of Le Fort I maxillary osteotomy: Cheever's operation. J Oral Surg 1981;39:731.
- Hedemark A, Freihofer HP Jr. The behaviour of the maxilla in vertical movements afte Le Fort I osteotomy. J Oral Maxillofac Surg 1978;6:244.
- Schuchardt K. Experience with the surgical treatment of deformities of the jaws; prognathia, micrognathia and open bite. In Wallace AB, editor. Second Congress of International Society of Plastic Surgeons. London: E & SS Livingstone;1959.
- Dingman RO, Harding RL. Treatment of malunion of facial bones. Plast Reconstr Surg 1951;7:505.
- Drammer RB. The history of the "Le Fort Iosteotomy, J Oral Maxillofac Surg 1986;14:119.
- Bell WH. Revascularization and bone healing after anterior maxllary osteotomy: a study using adult rhesus monkeys. J Oral Surg 1969;27:249.
- Bell WH, Mannai C, Luhr HG. Art and science of the Le Fort I down fracture. Int J Adult orthod orthognath Sur 1988;3:23.
- Bell WH. Modern practice in orthognathic and Reconstructive Surgery. Philadelphia: WB Saunders; 1992.p.2211-2223.
- Obwegeser HL. Surgical correction of small or retrodisplaced maxillae: The "dish-face" deformity. Plast Reconst Surg 1969;43:35.
- Wilmer K. On LeFort I osteotomy; A follow up study of 106 operated patients with maxillofacial deformities. Scand J Plast Reconstr Surg 1974;Supple 12:1-68.
- Wolford LW. Effects of orthognathic surgery on nasal form and function in the cleft palate patient. Cleft palate Craniofac J 1992;29:546.
- Al-Waheidi EMH, Harradine NWT, Orth M. Soft tissue profile charges in patients with cleft lip and palate folowing maxillary osteotomies. Cleft palate Craniof J 1998;35:535.
- Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980;38:744.
- Obwegeser H. Chirugia dell “mordex apparatus.” Rev Asoc Odontol Argent. 1962;50:429.
- Parula K, Finn, Oli Karinen K. Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg 2001;59:1128.
- Wolford L, Hellerd FW, Dugan DJ. Surgical treatment objective. St.Louis: CV Mosby Co; 1985.
- Nordenram A, Walker A. Oral surgical correction of mandibular protrusion. Br J Oral Surg 1968;64:75.
- McNeil, Proffit WR and White RP. Cephalometric prediction for orthognathic surgery. Angle Orthod 1972;42:154.
- Burstone CJ, James RB, Legan HC. Cepahlometrics for Orthognathic Surgery. Journal of Oral Surgery 1978;36:269-77.
- Kent, Hinds. Management of dental facial deformities by anterior alveolar surgery. J Oral Surg 1971;29:13-25.
- Ewing M, Ross RB. Soft tissue response to the osthognathic surgery in persons with unilateral cleft, lip and palate. Cleft Palate Craniofac J 1993;30:320-329.
- Schendel SA, Carlotti AE. Nasal considerations in orthognathic surgery. Am J Orthod Dentofac Orthop 1991;100:197.
- Moshiri F, Jung ST, Sclaroff A, Marsh JL, Gay DW. Orthognathic and craniofacial surgical diagnosis and treatment planning: A visual approach. J Clin Orthod 1982;16:37–59.
- Bell WH, Dann. Correction of dentofacial deformities by surgery in the anterior part of jaws: A study of stability and soft tissue changes. Am J Orthod, 1973;64: 162-186.
- Henderson D. A color atlas and textbook of orthognathic surgery-the surgery of facial skeletal deformity. Weert Netherland: Wolfe Medical Publications Ltd; 1985.p.224-225.
- Kole H. Surgical operations on the alveolar ridge to correct occlusal abnormalities. J Oral Surg 1959;12:227.
Abstract Views: 253
PDF Views: 151