LeFort 1 Osteotomy
Q: Dr. Eppley, I had a LeFort 1 osteotomy done two years ago and I’m looking for a revision as it was done poorly. For the first surgery, I only had rubber bands and was allowed to remove them after the first week for meals. (soft food) However, I’ve read of many cases whereby the patient is completely wired shut for weeks. Why do some patients have such strict fixation while others don’t? Would not getting wired shut lead to a greater chance of relapse or a poorer outcome?
A: Historically, LeFort 1 osteotomies were done using wire bone fixation and the need to use maxillomandibular fixation (jaws wired together) to hold the bone in place as it heals. Since the late 1980s and early 1990s, LeFort osteotomies have been held into place using plates and screws thus obviating the need for wiring the jaws shut after surgery for six weeks to allow the bones to heal.
While I have no idea what type of bony movements were done with your LeFort 1 osteotomy, your after care with temporary rubber bands suggest that you had plate and screw fixation. If properly done the use of plate and screw fixation would create a comparative result to wiring the jaws shut for six weeks. In theory long-term stability would be improved with the plate and screw fixation technique. The risk of a malaligned bite after a LeFort 1 osteotomy with the jaws wired shut for six weeks, as uncomfortable and historic as that is, has a lower risk than that if rigid plate and screws fixation.
Dr. Barry Eppley