Endoscopically assisted intraoral modified Le Fort II type midfacial advancement using piezoelectric surgery and an intraoperative RED system

J Oral Maxillofac Surg. 2013 Feb;71(2):e93-103. doi: 10.1016/j.joms.2012.10.007.


Purpose: 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.

Materials and 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.

Conclusion: 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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Cephalometry / methods
  • Cleft Lip / surgery
  • Cleft Palate / surgery
  • Endoscopes
  • Endoscopy / methods*
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / methods
  • Humans
  • Jaw Fixation Techniques / instrumentation
  • Male
  • Malocclusion, Angle Class III / surgery
  • Mandibular Osteotomy / methods
  • Maxilla / surgery
  • Maxillary Osteotomy / methods*
  • Minimally Invasive Surgical Procedures / methods
  • Nasal Bone / surgery
  • Nasal Cavity / surgery
  • Nose / surgery
  • Osteotomy, Le Fort / methods*
  • Patient Care Planning
  • Piezosurgery / methods*
  • Surgery, Computer-Assisted / methods
  • Traction / instrumentation*
  • Young Adult