Osteotomy Lefort 1
– Osteotomy: medical term for action to cut the bone.
– Maxillary sinuses: bone cavities and symmetrical pairs, filled with air, located on either side of the nasal cavity and communicating with them.
– René Le Fort, René Lefort born (1869-1951) French military surgeon and medical academy member who studies including fractures of facial bones. The name of the osteotomy Lefort 1 dedicated to him.
The osteotomy Lefort 1 allows to change the position of the toothed portion of the jaws with respect to the mandible and the rest of the face.
Outcome of surgery
The procedure is performed under general anesthesia. Excluding pre-operative complication there is no skin scar, since the entirety of surgical approaches is made in the mouth.
After incising the mucosa above the upper dental arch, the jaws are cut in order to disengage their toothed portion from the rest of the bone structure of the face.
The osteotomy passes through the maxillary sinuses and nasal cavities. This can make easy a gesture on the nasal septum and inferior turbinate if needed.
The toothed portion is then positioned in the cephalometric analysis of the patient and according to the desired dental occlusion. Then the bone fragments are joined by mini plates and screws mini. The surgical approaches are sutured with absorbable son.
Elastic orthodontic can be set up to help the patient get used to his new dental articulation. They do not prevent opening the mouth or eating. Mostly they hang on orthodontic appliance. If it does not allow, transmucosal screws will be used for this purpose.
Changing the position of the toothed portion of the jaws permits reuse is open jaws relative to the other. The facial appearance is thereby necessarily changed and we must have realized before considering this type of intervention.
Mini plates are invisible after the procedure because they are in contact with the bone and covered by mucous. They can stabilize the displaced bone fragment in the desired position. However it is not as strong as the natural bone and therefore it is desirable not to force it as the bone has healed. A soft diet for 6 week and no activity is risk of trauma to the jaw during 3 months are required after surgery.
usual postoperative and post-operative care
This type of surgery usually requires hospitalization rule 3 at 5 days.
Swelling of the face can be very important, it is maximal at 48 hours of the intervention and gradually fades in 2 at 3 weeks. Why a downtime and work stoppage during this period are advised.
The pain in the operated areas often gives with analgesics and disappears in a few days.
ice packs coated with a cloth (not directly on the skin) decrease swelling and pain.
Often small bleeding persists for a few days & rsquo; Intervention. The treatment consists of mouthwash in ice water and apply a compress on the area that is bleeding and bite very gently on it until the bleeding does s & rsquo; not stop. It is also possible that a blackish nosebleed persists a few days after surgery, it is simply the blood that was still present in the sinuses drains.
The son of sutures are absorbable and fall alone from 15 days. A very soft surgical toothbrush is required to clean and avoid becoming irritating due to the presence of plaque.
Good oral hygiene is essential for the healing is done without complication. After each meal, teeth and gums should be cleaned by brushing. mouthwash are prescribed in addition to brushing.
As the osteotomy passes through the maxillary sinuses and nasal cavities it is recommended not to blow hard during the 3 weeks following the intervention on pain create a communication between the mouth and sinuses. In this nose washes are prescribed saline to clean nasal cavities and speed the recovery of normal nasal ventilation.
Food should not be hard for the 6 weeks after surgery otherwise bend or loosen mini plates. Besides eating hard foods on surgical approaches is painful and promotes infections. Specifically: During the 2 first days, the diet should be soft, warm or cold. Then during the 12 days Avoid very salty or very acidic foods. Also avoid offensive foods: biscuits, toast, chips ... Also avoid very small items that could come between the dots and create infections semolina, peanuts, rice, peas…
Finally continue for 4 weeks with a soft diet for a total ensure the healing bone ongoing lack of food trauma 6 weeks. You will find on the site https://docteurwajszczak.fr in the section advice recipe ideas suited to you after this type of surgery.
Tobacco is avoided in the aftermath of the intervention, it decreases the mucosa and bone healing, promotes infection and increases the post operative pain. Alcohol is not compatible with the medications prescribed after surgery and is also prohibited.
Mini mini plates and screws implanted to stabilize the bone fragments can be palpable and become annoying. This is why it is advisable to remove once the bone healed (between 6 months 1 an). This procedure is done under general anesthesia but also it is an act much lighter than that caused their poses and performed most often in outpatient.
If elastic tie down bolts were put, it will be removed in consultation with 3 weeks of intervention. And generally setting the elastic is done 15 days of the intervention by the orthodontist.
Several consultations checks are carried out in the aftermath of the intervention by both the maxillofacial surgeon by the orthodontist. They help ensure the proper development of postoperative.
Post-operative orders are given most of the time before surgery. This will fetch the post operative medication before surgery and have it available directly on the day of the release of the clinic.
Risks and Complications
Any medical procedure, very well led, harbors a risk of complications. Do not hesitate to contact the surgical team that took care of you, or clinical emergencies or contact 15 in case of serious emergency.
There may be rare complications:
The stitches all fall alone and in mucosal general rule is already healed. But if they fall prematurely or if the lining does not heal the surgical approach may reopen. If this disunity points causes a small opening it heal spontaneously but the take some time. However if disunity is important it will be necessary to put points.
An infection of the soft tissues of the cheek (cellulitis) can occur days or even 2 at 3 weeks after surgery. It is consecutive to the stagnation of food residue in the surgical. It gives a suitable antibiotic treatment, exceptionally it may be necessary to carry out surgery to drain an abscess if cellulite is complicated.
A hematoma can occur in the operating suites. If it is small it will resolve spontaneously, however it is important it will be necessary to evacuate surgically.
If there is a fragility of temporomandibular joint intervention can decompensate it and cause a limited mouth opening, pain and joint cracking. In the vast majority of cases everything is in order in a few weeks.
Decrease or loss of sensitivity of the upper lip or teeth: The maxillary nerve is located just above the bone section. It can be stretched resulting in a transient decrease in sensitivity usually disappears completely after a few weeks or months
Or exceptional complications:
When trimming a strong disunity of the scar can occur and cause communication between the maxillary sinus in the mouth. If this communication is important it will be closed surgically.
Trauma occurring on mini plates while the bone is not well healed may twist, loosen or break. It is then necessary to replace these plates and is done under general anesthesia.
bone healing jaw out of position: when it comes to small shifts, the treatment may simply be to reposition the jaw in a good position with elastic chin, gesture that will eventually be strengthened by the targeted teeth grinding. If travel is important, reoperation may be necessary.
Delay or absence of bone healing: very rare, it requires to carry out a new intervention sometimes with bone graft.
In very rare cases, dental roots may be injured and require treatment (apicectomy, devitalization, implant in case of tooth loss). Sometimes some teeth are temporarily a little sensitive after grinding.
Paralysis of the muscles of the face: it is exceptional and usually regressive.
Local vascular disorders: very rare, they cause a retraction of the gums, loss of bone and teeth in extreme cases or in rare cases a maxillo-palatal necrosis.
In total, should not overstate the risks, but just be aware that surgery, even seemingly simple, still a small share of hazards.
It is very important to bring the day of the procedure: the plaster study models, All radiographs: dental panoramic, teleradiographs craniofacial front and profile and the scanner if it had been prescribed a. Without these intervention can not be performed