Le Fort I Osteotomy

The Le Fort I osteotomy is the workhorse of orthognathic surgery. The maxilla is separated above the tooth roots and repositioned forward, upward, downward, or rotationally, then fixed with titanium plates. It is planned with orthodontics, cephalometric analysis, and increasingly with virtual surgical planning from CBCT data.

• Position and angulation of the upper jaw
• Occlusal plane and bite relationship
• Midface projection and paranasal support
• Upper lip position and incisor show
• Nasal base width and tip rotation (secondary effects)

• General physical health suitable for the anaesthetic required
• Realistic, clearly articulated aesthetic or functional goals
• Stable anatomy appropriate for the technique proposed
• Non-smoking or willingness to stop for the surgeon's required window

1. 01Intraoral incision in the upper buccal sulcus — no external scars
2. 02Horizontal osteotomy above the tooth roots and down-fracture of the maxilla
3. 03Repositioning using a surgical splint or patient-specific guides
4. 04Rigid fixation with titanium plates and screws

1. Day 1

   Overnight hospital stay, significant facial swelling, liquid diet, elastics guiding the bite.

2. Week 1

   Peak swelling. Liquids only, meticulous oral hygiene, speech is effortful.

3. Week 2

   Swelling begins to drop. Soft diet, short walks, return to desk work for some people.

4. Week 4

   Most social swelling resolved. Progressive diet advancement as directed.

5. Month 3

   Bone consolidation well advanced, orthodontic finishing typically underway.

6. Month 6

   Facial contour near-final; sensory recovery in the cheek and lip continues.

7. Month 12+

   Final result and skeletal stability assessed; nerve recovery may still improve.