LeFort 1 Osteotomy

Q: Dr. Eppley, I wanted to ask, in a Lefort 1 osteotomy, is it possible to lengthen the nose along with that part of the maxilla. Part of my problem with my midface is a nose that is short vertically compared to the distance between eye to eye horizontally. So is it possible to lengthen the nose within the Lefort 1 osteotomy? I am asking because I saw this Lefort 1 osteotomy example, and wanted to know if the bone grafts also applied to lengthening the nose vertically? And if so, by how much?

A: While diagrams and actual LeFort I osteotomy down fractures (vertical lengthening) do show the pyriform aperture (nasal base) being opened up and/or bone grafted, this will not vertically lengthen the nose. The shape of the external nose is largely controlled by the cartilaginous support system. (septum, upper and lower alar cartilages) This to vertically lengthening the nose cartilage grafts must be placed on TOP of the existing cartilage support. Nothing done underneath it will lengthen the external nose shape. In fact, vertical lengthening of the midface will actually create a relatively greater deficiency of the nose, more of a potentially saddle dorsal line appearance rather than the opposite effect which you desire.

Dr. Barry Eppley
Indianapolis, Indiana