LeFort III Osteotomy
Q: Dr. Eppley, Thanks for responding to my first inquiry concerning the LeFort III osteotomy. I would like to ask you something else, concerning the orbital rims. I was doing a research on these online and amongst some useful information – I did not know about the existence of orbital rim, infraorbital rim implants- I could get, I came across the following statement :
“Those with recessed infraorbital rims usually have recessed eyeballs too, because a retruded maxilla pushes the eyes back. This creates an unaesthetic upper eyelid area with the upper eyelids drooping backward from the brow ridge. Or lack of hooded eyelids. In order for the eye area to be aesthetic, the eyeballs themselves have to be set forward too. Orbital rim implants won’t fix recessed eyeballs. Only a Le Fort III does because it creates space for the eyeballs to project forward. When the orbital rims come forward, the eyeballs themselves would come forward too.”
Infraorbital rim implants only fixes 25% of the problem as a Le Fort III does to the eye area. It does not project the paranasal area forward. It also does not project the eyeballs themselves forward.”
Is the above statement true at all? Wouldn’t only syndrome patients qualify for a LeFort III osteotomy?
A: To clarify your question, a LeFort III moves the infraorbital rims forward but it does not and can not move the eye forward. The globe (eyeball) is on a fixed tether so to speak. (the optic nerve and the surrounding extra ocular muscles) These critical soft tissue attachments do not permit the eyeball to move forward. That is, essentially, an impossibility. This is well known and observed as a LeFort III corrects the proptosis (bulging eyes) that appear in numerous craniofacial syndromes. By bring the infraorbital rims forward, the static position of the globe will become less proptotic because the eyeball stays in the same position…only the bone moves. This is one of the main reasons (beside the malocclusion) why only syndromic cramiofacial patients have a LeFort III osteotomy because of their orbital proptosis.
I don’t think you really understand the magnitude of a LeFort III operation. It is not simple and clean like it appears in an illustration or diagram. It is a procedure that has a lot of aesthetic trade-offs from the scalp scar down to the bony irregularities across the the nose to the cheeks. It is far from being an aesthetic operation. Because of the scope of the surgery and the numerous other issues that it causes, it is reversed for those patients in whom the magnitude of the problem makes even these aesthetic trade-offs worthwhile. (in other words they have significant functional issues) This is far from the case of a purely aesthetic patient who seeks to just have their eye appearance improved.
Dr. Barry Eppley