Modified Anterior Z Le Fort III Osteotomy

Introduction

Surgery of the midface for non-syndromic patients with maxillo-malar hypoplasia exclusively has had many breakthroughs lately. The surgical techniques for midface surgery are varied and must be selected according to the patient's problem.

Purpose

The technique is a modification of the Z Osteotomy, the Modified Anterior Z Le Fort III Osteotomy (MAZLFIIIO), is used to correct posteroanterior midface deficiency of 6 mm at most. It can be combined simultaneously with a Le Fort I osteotomy if a greater maxillary advance is needed. MAZLFIIIO advances midface without grafts or distraction osteogenesis. The anterior reposition of the midface is calculated in millimetres and depends on the relation of the eye's most inferior point, as well as the orbital's hard and soft tissues. It is a predictable osteotomy, only for patients without vertical excess of the midface. The osteotomy planned is drawn over a stereolithographic model, and then Z-shaped surgical splints are fabricated over it. Transverse midface deficiencies of no more than 4 mm can also be corrected during the malar osteotomy. A great number of patients are operated exclusively with Le Fort I osteotomies, leaving behind an undesirable step between the upper part of the midface and the Le Fort I osteotomy.

Methods

The Modified anterior Z Le Fort III Osteotomy (MAZLFIIIO) was performed in seven patients, from 2016 to 2018.

Results

The results obtained with the proposed osteotomy notably improve the appearance of the patient and provide a better protection of the lower part of the eye, while widening the maxillary sinus.

Conclusion

We consider that maxillo-malar hypoplasias are very common; the surgeon pretends not to give importance to the deformity, exclusively using an advance Le Fort type osteotomy, with both functional and aesthetic treatment being limited. In this article, we give all the elements to perform this Le Fort III Modified Osteotomy in anterior Z, and that it is a combined and routine procedure in midface surgery.

Orthognathic Surgery in Patients with Syndromic Craniosynostosis

Patients with syndromic and nonsyndromic synostosis may have end-stage skeletal discrepancies involving the lower midface and mandible, with associated malocclusion. While orthognathic surgical procedures in this population can be reliably executed, the surgeon must be aware of the unique morphologic characteristics that accompany the primary diagnoses as well as the technical challenges associated with performing Le Fort I osteotomies in patients who have undergone prior subcranial midface distraction.

Hard- and soft-tissue profiles of the midface region in patients with skeletal Class III malocclusion using cone-beam computed tomography multiplanar-reconstructed image analysis

Objective

This study examined cone-beam computed tomography (CBCT)-derived multiplanar-reconstructed (MPR) cross-sections to clarify the salient characteristics of patients with skeletal class III malocclusion with midface deficiency (MD).

Methods

The horizontal and sagittal plane intersection points were identified for middle-third facial analysis in 40 patients in the MD or normal (N) groups. MPR images acquired parallel to each horizontal plane were used for length and angular measurements.

Results

A comparison of the MD and N groups revealed significant differences in the zygoma prominence among female patients. The convex zygomatic area in the N group was larger than that in the MD group, and the inferior part of the midface in the N group was smaller than that in the MD group for both male and female patients. A significant difference was observed in the concave middle maxillary area among male patients.

Conclusions

This study was conducted to demonstrate the difference between MD and normal face through MPR images derived from CBCT. Male patients in the MD group had a more flattened face than did those in the N group. Female patients in the MD group showed a concave-shaped lower section of the zygoma, which tended to have more severe MD. These findings indicate that orthognathic surgery to improve skeletal discrepancy requires different approaches in male and female patients.