Technical Modifications for Intraoral Quadrangular Le Fort II Osteotomy.
OBJECTIVE
The intraoral quadrangular Le Fort II osteotomy (IQLFIIO) represents a reliable surgical method in cases of midfacial deficiency with good functional, esthetic, and stable long-term results.


METHODS
In this technical note, we present 3 surgical modifications to previous reports: 1) inferior orbital rim osteotomy by angulated piezosurgical instruments, thereby avoiding the use of chisels in the orbital region; 2) osteosynthetic fixation only laterally at the zygomatic buttress with 2 L-shaped miniplates, thus avoiding paranasal osteosynthesis; and 3) advancement step camouflage in the lateral infraorbital region with a compound mass of autologous bone chips and fibrin glue with the intention to reduce bone block-associated side effects.


RESULTS
Thirteen consecutive patients presenting with midfacial deficiency and Class III malocclusion were treated by IQLFIIO and mandibular osteotomy. In all cases, osteotomy and consecutive down fracture could be conducted as planned using the piezotome. No atypical fractures were encountered. No cases of infraorbital nerve anesthesia developed. Midfacial hypesthesia was found in 54% of the operated sides after 3 months, in 23% after 6 months, and in 13% after 12 months. The 5-month postoperative 3-dimensional scans revealed osseous healing at the infraorbital advancement step.


CONCLUSIONS
Our results suggest that IQLFIIO can be conducted fully without chisels in the orbital region. Implementation of piezosurgery in IQLFIIO allows for safe bone cutting in the orbital region. Two miniplates and step camouflage with fibrin glue-stabilized bone chips were sufficient for osseous healing. Future studies will focus on quantitative soft to hard tissue changes that occur with IQLFIIO advancement.
Attending Professor, Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
Clemens
C
Klug
Resident, Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: julia.cede@meduniwien.ac.at.
Julia
J
Cede
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D059745:Piezosurgery; D012189:Retrospective Studies; D055815:Young Adult