Endoscopically assisted intraoral modified Le Fort II type midfacial advancement using piezoelectric surgery and an intraoperative RED system.
OBJECTIVE
The Le Fort II midfacial advancement appears to be an effective surgical method for the treatment of severe midfacial-nose hypoplasia with a skeletal class III malocclusion, which is usually combined with syndromic midfacial anomalies. However, the conventional surgical method requires the coronal approach, including a coronal incision, together with other surgical approaches, such as an intraoral incision. Therefore, surgeons often hesitate to propose this type of osteotomy, even for patients who develop severe nonsyndromic midfacial-nose hypoplasia. This report presents a new surgical approach for performing a safe Le Fort II osteotomy for nasomaxillary, midfacial corrective advancement via a solely intraoral approach.


METHODS
Surgery was performed with endoscopically assisted piezoelectric surgery. The osteotomized nasomaxillary Le Fort II segment was successfully protracted without aggressive down-fracture procedures with the sole intraoperative use of a rigid external distraction (RED) system, followed by internal rigid fixation, and the subsequent removal of the RED system. Seven patients (all patients were nonsyndromic, but 2 had cleft lip and palate, and an average age of 19.9 years) were included in this study.


RESULTS
The degrees of midfacial advancement at the base of nasal bone (the top edge of the modified Le Fort II segment) that was osteotomized and at maxillary point A was 8.3 mm (range 5.8 mm to 10.5mm) and 8.5 mm (range 5.9 mm to 9.8 mm), respectively.


CONCLUSIONS
This new method less invasively facilitates safe, secure, and ideal nasomaxillary midfacial protraction to yield a satisfactory resultant facial profile and favorable occlusion in patients with severe midfacial-nose hypoplasia and skeletal class III malocclusions.
Department of Oral and Maxillofacial Surgery, Kochi Health Sciences Center, Kochi, Japan. shingo_hara_kochi@live.jp
Shingo
S
Hara
Masaharu
M
Mitsugi
Takahiro
T
Kanno
Akihiko
A
Nomachi
Seiichi
S
Kawakami
Yukihiro
Y
Tatemoto
D000293:Adolescent; D000328:Adult; D002508:Cephalometry / Q000379:methods; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D063168:Mandibular Osteotomy / Q000379:methods; D008437:Maxilla / Q000601:surgery; D063166:Maxillary Osteotomy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009295:Nasal Bone / Q000601:surgery; D009296:Nasal Cavity / Q000601:surgery; D009666:Nose / Q000601:surgery; D019340:Osteotomy, Le Fort / Q000379:methods*; D010347:Patient Care Planning; D059745:Piezosurgery / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods; D014143:Traction / Q000295:instrumentation*; D055815:Young Adult