From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California; and the Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles.
Plast Reconstr Surg. 2020 Jun;145(6):1067e-1072e. doi: 10.1097/PRS.0000000000006816.
Midface hypoplasia dramatically affects the normative facial cascade. Simultaneous Le Fort III and Le Fort I procedures (Le Fort III/I) provide a powerful tool for achieving significant midface advancement. This study presents the authors' approach for addressing midface hypoplasia in the setting of class III malocclusion using Le Fort III/I advancement.
This was an institutional review board-approved retrospective review of patients who underwent Le Fort III/I advancement at the authors' institution from 2009 to 2019. Demographic, surgical, and postoperative data were recorded. The authors' operative technique and surgical pearls are described.
Twenty-five patients met inclusion criteria, 15 male patients (60 percent) and 10 female patients (40 percent). Patient age ranged from 14.9 to 21.6 years. Diagnoses included Crouzon syndrome, nonsyndromic developmental skeletal dysplasia, cleft lip/palate, Klippel-Feil syndrome, Apert syndrome, Van den Ende-Gupta syndrome, and Pfeiffer syndrome. Le Fort III advancements averaged 6.18 ± 1.38 mm and Le Fort I advancements averaged 6.70 ± 2.48 mm. Thirteen patients underwent simultaneous bilateral sagittal split osteotomy with average movement of 5.85 ± 1.21 mm. Average follow-up was 1.3 ± 1.0 years. One patient experienced intraoperative cerebrospinal fluid leak that resolved with expectant management. Three patients experienced major complications (12 percent) postoperatively necessitating repeated orthognathic operations. Ten patients experienced minor complications (40 percent). Average length of stay was 10 days, with all patients achieving improvement of their facial profile.
The authors' experience reaffirms the relative safety of simultaneous Le Fort III/I advancement. This technique should be considered in select patients with global midface retrusion and class III malocclusion.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
中面部发育不全显著影响正常的面部发育序列。同期 Le Fort III 和 Le Fort I 手术（Le Fort III/I）为实现显著的中面部推进提供了有力的工具。本研究介绍了作者在 III 类错颌畸形中使用 Le Fort III/I 推进治疗中面部发育不全的方法。
这是一项机构审查委员会批准的回顾性研究，纳入了 2009 年至 2019 年期间在作者所在机构接受 Le Fort III/I 推进手术的患者。记录了患者的人口统计学、手术和术后数据。作者描述了手术技术和手术要点。
25 名患者符合纳入标准，其中男性 15 名（60%），女性 10 名（40%）。患者年龄为 14.9 至 21.6 岁。诊断包括 Crouzon 综合征、非综合征性发育性骨骼发育不良、唇腭裂、Klippel-Feil 综合征、Apert 综合征、Van den Ende-Gupta 综合征和 Pfeiffer 综合征。Le Fort III 平均推进 6.18 ± 1.38mm，Le Fort I 平均推进 6.70 ± 2.48mm。13 名患者同期行双侧下颌骨矢状劈开截骨术，平均移动 5.85 ± 1.21mm。平均随访时间为 1.3 ± 1.0 年。1 名患者术中发生脑脊液漏，经期待治疗后痊愈。3 名患者术后发生严重并发症（12%），需要再次行正颌手术。10 名患者发生轻微并发症（40%）。平均住院时间为 10 天，所有患者的面型均得到改善。
作者的经验再次证实了同期 Le Fort III/I 推进的相对安全性。对于具有全面中面部后缩和 III 类错颌的特定患者，应考虑使用这种技术。
临床问题/证据水平：治疗性，IV。
