Modified Anterior Z Le Fort III Osteotomy

Garcia Y Sánchez Jose Manuel; D A Valdes Martínez; Lopez Bonilla Salvador; Rosales Díaz Mirón Dayel Gerardo; Estrada Orozco Juan José; Elizalde Monroy Martin; Reyes Huerta Pablo

doi:10.1007/s12663-021-01620-2

Modified Anterior Z Le Fort III Osteotomy

J Maxillofac Oral Surg. 2023 Mar;22(1):201-216. doi: 10.1007/s12663-021-01620-2. Epub 2021 Sep 28.

Authors

Garcia Y Sánchez Jose Manuel¹, D A Valdes Martínez², Lopez Bonilla Salvador³, Rosales Díaz Mirón Dayel Gerardo⁴, Estrada Orozco Juan José¹, Elizalde Monroy Martin¹, Reyes Huerta Pablo⁵

Affiliations

¹ Maxillofacial Surgery Department, Medical Specialities Hospital, Centro Medico Nacional Century XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de Mexico, Mexico.
² Maxillofacial Surgeon Private Practice, Ciudad de Mexico, Mexico.
³ Maxillofacial Surgery Department, Medical Specialities Hospital San Jose, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico.
⁴ Maxillofacial Surgeon Private Practice, Torreón, México.
⁵ Maxillofacial Surgeon Private Practice, Ciudad Victoria, México.

Abstract

Introduction: Surgery of the midface for non-syndromic patients with maxillo-malar hypoplasia exclusively has had many breakthroughs lately. The surgical techniques for midface surgery are varied and must be selected according to the patient's problem.

Purpose: The technique is a modification of the Z Osteotomy, the Modified Anterior Z Le Fort III Osteotomy (MAZLFIIIO), is used to correct posteroanterior midface deficiency of 6 mm at most. It can be combined simultaneously with a Le Fort I osteotomy if a greater maxillary advance is needed. MAZLFIIIO advances midface without grafts or distraction osteogenesis. The anterior reposition of the midface is calculated in millimetres and depends on the relation of the eye's most inferior point, as well as the orbital's hard and soft tissues. It is a predictable osteotomy, only for patients without vertical excess of the midface. The osteotomy planned is drawn over a stereolithographic model, and then Z-shaped surgical splints are fabricated over it. Transverse midface deficiencies of no more than 4 mm can also be corrected during the malar osteotomy. A great number of patients are operated exclusively with Le Fort I osteotomies, leaving behind an undesirable step between the upper part of the midface and the Le Fort I osteotomy.

Methods: The Modified anterior Z Le Fort III Osteotomy (MAZLFIIIO) was performed in seven patients, from 2016 to 2018.

Results: The results obtained with the proposed osteotomy notably improve the appearance of the patient and provide a better protection of the lower part of the eye, while widening the maxillary sinus.

Conclusion: We consider that maxillo-malar hypoplasias are very common; the surgeon pretends not to give importance to the deformity, exclusively using an advance Le Fort type osteotomy, with both functional and aesthetic treatment being limited. In this article, we give all the elements to perform this Le Fort III Modified Osteotomy in anterior Z, and that it is a combined and routine procedure in midface surgery.

Keywords: 3d stereolithographic model; Midface deficiency; Modified Anterior Z Le Fort III osteotomy.