Horseshoe Le Fort I osteotomy for gummy smile and facial asymmetry: Two cases

Abstract

Introduction: In cases with gummy smile or asymmetry of the maxilla, superior repositioning of the maxilla is required. If superior repositioning by a Le Fort I osteotomy alone is difficult, a horseshoe Le Fort I osteotomy can be used. Presentation of cases: Case 1: A 24-year-old Japanese woman patient presented with a gummy smile and an open bite. After we performed a horseshoe Le Fort I osteotomy, the maxillary segment was repositioned superiorly 3.0 mm at upper tooth number 1 (U1) and 5.0 mm at upper tooth number 6 (U6). Case 2: A 21-year-old Japanese man presented with severe facial asymmetry. After we performed a unilateral modified horseshoe Le Fort I osteotomy, the maxillary segment was superiorly repositioned 6.0 mm at the right U6. Discussion: This procedure eliminated the risk of intraoperative bleeding because it was unnecessary to remove bones around the descending palatine artery, and it was possible to maintain the chamber size of the nasal cavities. Conclusion: The horseshoe Le Fort I osteotomy is a reliable technique for cases with severe gummy smile or asymmetry of the maxilla.