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The Popescu Modification for the Le Fort III Osteotomy: Nasal Bone Sparing Midface Advancement
Haruko Okada, MD
Ali Totonchi, MD
Arun Gosain, MD
2010-03-31
Presenter: Haruko Okada
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
In a subset of patients with midface hypoplasia requiring the Le Fort III advancement, the transverse osteotomy made at the nasion would result in excessive projection of the nasal bones and an unaesthetic change in the frontonasal angle. Thus a variation of the osteotomy omitting the nose should be in our repertoire. In 1974, Valerian Popescu described such a variation. We have found the Popescu modification particularly useful in patients with midface hypoplasia secondary to cleft lip and palate as many of these patients require midface advancement to include the inferior orbital rim, but not at level of the nasion. We have also used the technique in patients with syndromic or idiopathic midface hypoplasia that does not extend to the nasion.
In our series of seven patients, the preoperative diagnoses were midface hypoplasia, midface hypoplasia with craniosynostosis, Crouzon's Syndrome, and cleft lip and palate. Six underwent distraction osteogenesis, and one had bone grafts with rigid fixation. Of those who underwent distraction, four used the Kawamoto internal distractor, two used the Gosain internal distractor, and one used the RED external distractor. On preoperative lateral view photographs for each patient, a vertical line was drawn tangentially from the glabella, intersecting the nasal dorsum. Our patients who underwent this operation had enough nasal projection that this line intersected the nasal dorsum within its upper one third.
The Popescu modification of the Le Fort III osteotomy is a valuable asset for patients who require midface advancement without change in nasal projection.
