Simultaneous Le Fort III and Le Fort I osteotomies for correction of midface hypoplasia in Crouzon syndrome

Abstract

Le Fort III osteotomy is commonly indicated for the treatment of midface hypoplasia in Crouzon syndrome. However, if there is significant maxillary dentoalveolar protrusion associated with midface hypoplasia, the use of Le Fort III osteotomy alone for midface advancement will result in a poor facial aesthetic outcome. We have recently published a new treatment strategy of correcting this form of deformity by a combination of simultaneous Le Fort III and Le Fort I osteotomies for non-syndromic cases. We would like to report a case of 16-year-old girl presenting with Crouzon syndrome with orbital proptosis, which is caused by a combination of zygomatico-naso-maxillary hypoplasia, as well as maxillary and mandibular dento-alveolar hyperplasia. A combined orthognathic surgical procedure of simultaneous Le Fort III and Le Fort I osteotomies were performed to correct the midface hypoplasia and maxillary dentoalveolar protrusion, while the mandibular dentoalveolar hyperplasia was corrected by a mandibular sub-apical osteotomy. The operation went uneventfully with 10 mm advancement of the midface achieving eye protection, occlusal correction and significant facial aesthetic improvement. At 12 months post-operatively, the aesthetic and occlusal results were stable and the patient was very pleased with the clinical outcome. This case was performed in collaboration between the Oral Health Division, Ministry of Health Malaysia and the Faculty of Dentistry, The University of Hong Kong. The report illustrates the clinical outcomes of the simultaneous Le Fort III and Le Fort I osteotomies for the correction of midface hypoplasia and maxillary dentoalveolar protrusion presenting in a Crouzon syndrome patient.