Le Fort II Osteotomy and Advancement

Adi Rachmiel

Dekel Shilo

Omri Emodi

PATIENT HISTORY AND PHYSICAL FINDINGS

Midface deficiency can be secondary to
- Traumatic deficiencies
  - Need to assess mechanism of injury
  - Assess for the presence of functional problems including
    - Breathing difficulty
    - Eating problems
    - Speech problems
- Nasomaxillary dysplasia
  - Assess breathing, eating, and speech problems.
- Cleft deformities
  - Assess breathing, eating, and speech problems.
  - Assess for potential palatal fistulas and need for bone grafting.

IMAGING AND OTHER DIAGNOSTIC STUDIES

Lateral cephalogram
Posteroanterior cephalogram
Cone-beam computed tomography (CBCT) or spiral CT scan
Cast models of the upper and lower jaws, setting the models in the articulator

SURGICAL MANAGEMENT

Preoperative Planning

Preoperative CBCT or spiral CT with lateral and posteroanterior cephalogram
Model casts are placed for assessment of occlusion. Preoperative orthodontics require leveling, alignment, and decompensation-retrusion of the upper dental arch and protrusion of the lower incisors to increase the amount of skeletal advancement.
Prefabricate an occlusal wafer according to the predetermined planned position of the midface.

FIG 1 • Bi-coronal approach. A. Marking of the coronal incision, notice the hairline. B. Following flap elevation notice the exposure of the nasofrontal suture and the medial orbital wall.

Positioning