A novel modification in combined Le Fort I and horseshoe osteotomy for posterior repositioning of the maxilla

Objective

Posterior repositioning of the maxilla using a novel modification in combined Le Fort I and horseshoe osteotomy in bimaxillary surgeries is described and assessed for accuracy.

Materials and methods

In this prospective study, posterior repositioning of maxilla was performed in a total of 10 patients where the planned posterior setback was at least 3 mm or greater. In all patients, the maxilla was first osteotomized with Le Fort I and horseshoe osteotomy in addition to a new technique to trim maxillary tuberosity and posterior palatal walls, and followed by bilateral sagittal split ramus osteotomy in the mandible with or without additional genioplasty. Lateral cephalograms were obtained preoperatively and 1 week postoperatively. The changes in upper incisor (U1) and upper molar mesial cusp tip (UMT) were examined.

Results

The discrepancy between the planned and actual posterior movement was 0.35 and 0.28 mm at U1 and UMT, respectively. There were no severe complications such as intraoperative haemorrhage, avascular necrosis of the maxilla (partial/total), devitalization of teeth, and oroantral or oronasal fistulas in any of the cases.

Conclusions

These results suggest that when greater posterior repositioning of the maxilla is indicated, this newly introduced novel modification in horseshoe osteotomy combined with Le Fort I osteotomy is an effective technique for safety and accuracy.