Should Custom Midface Implants Be Placed During Or After LeFort Surgery?

Q: Dr. Eppley, There is this recent study published by you: 

“….a custom implant design allows for a smooth augmentation effect that can blend in with a previous underlying LeFort I osteotomy.” Is it better and more controlled to place such implants after healing from a LeFort 1 or high LeFort 1 or is it better to place them while performing a LeFort 1? 

Thank you.

A: That is a good question whose answer would be influenced by the exact LeFort movement. If a horizontal advancement was involved (and I suspect that is to what you may be referring) then I would wait and do it secondarily because you would then have an implant exposed to the wide open maxillary sinus cavity below it….increasing the risk of infection. And if it as a ‘high’ Lefort osteotomy that osteotomy line is a bit more uncontrolled. Thus the match between what superior augmentation is needed and how the augmentation would blend in to the repositioned bone below it is not precisely known.

In short wait 6 months after the LeFort osteotomy and use a new 3D CT scan to make a precise implant fit that has less risk of infection.

Dr. Barry Eppley

Indianapolis, Indiana