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Combined Le Fort III and Le Fort I Osteotomies: Systematic Literature Review and Case Presentation
Matthew S. Brown
Haruko Okada
Gregory E Lakin
University Hospitals
2013-03-19
Presenter: Matthew Brown
Affidavit:
The majority of the work was performed by the resident
Director Name: Hooman Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Objective: A combined Le Fort III and Le Fort I Osteotomy was first described by Dr. Obwegeser in 1969 and since that time there have been case reports and small case series described in the literature. A literature review was conducted to collectively summarize the documented reports and a new case of simultaneous Le Fort III and Le Fort I is presented to describe and discuss specific operative indications and surgical decisions.
Methods: A PubMed search using "Le Fort III", "Dual Midface", and "Segmental Midface" was performed. 646 individual articles were identified. Titles and abstracts were reviewed. Articles with relevant abstracts were obtained for formal review.
Results: 14 articles were identified that met inclusion with reports of simultaneous Le Fort III and Le Fort I osteotomies. 18 cases with a mean age of 21 years were present in the literature. We performed combined Le Fort III with Le Fort I in a 25 year old Crouzon patient with a previous Le Fort III at the age of 4. Postoperatively her exophthalmos and class III malocclusion were corrected.
Conclusions: Simultaneous Le Fort III and Le Fort I can correct differential upper and lower midface hypoplasia and is a well tolerated procedure in the mature facial skeleton. This systematic review improves our understanding of the surgical technique and indications for a procedure which can correct complex midfacial deformities. We also present the first case of a secondary Le Fort III with simultaneous Le Fort I with a successful post-operative result.
