[Le Fort I osteotomies combined with post-operative bone grafts]

Abstract

Introduction: We present and assess a surgical technique for maxillary auto-bone grafting concomitantly with Le Fort I osteotomy. The graft has 2 main objectives: to fill in the space between the 2 advanced segments of the maxilla to help bone consolidation, and to increase the volume of the malar, para-nasal spaces to improve post-operative esthetic results.

Technical note: Bone fragments, removed during the Le Fort I osteotomy, are stored and wrapped in a Surgicel(®) sheet, then grafted in the space left by the osteotomy, or on the anterior maxilla in the para-nasal area or on the malar bone. One hundred and twenty-three patient records, operated from 2007 to 2012, were collected to assess the post-operative course retrospectively. The post-operative course was uneventful in 93.5% of cases. About 8.4% of patients (7 cases) presented with a persistent post-operative maxillary edema. 1 patient (1.2%) presented with a sinus infection without any determined etiology. The grafts were all osteointegrated at the end of follow-up.

Discussion: The technique is simple and quickly performed; it improves bone healing and cosmetic results, without increasing morbidity or surgical time. It is a good alternative to bone grafts from a secondary sample site. It can be applied to all Le Fort I osteotomies.

Keywords: Bone grafting; Chirurgie orthognathique; Greffe osseuse; Le Fort I osteotomy; Orthognathic surgery; Ostéotomie de Le Fort I.