Procedure for 1981 Le Fort I ... probably same still !
Posted: Fri Aug 10, 2007 8:52 pm
I received more medical records for my Le Fort I osteotomy. It was done in 1981, not 1980 as I had remembered. Here is what the surgeon reported after the operation, I'm guessing the procedure is very similar these days except for the transossesous wiring and fixation with arch bars.
If anyone else has operation reports, I would love to read them !
========
With the patient in the supine position and under satisfactory nasal tracheal anesthesia, she was prepped and draped in the usual fashion for a transoral procedure. The oropharynx was suctioned and a throat pack placed. Erich arch bars were then applied to the maxillary and mandibular arches utilizing 23 gauge stainless steel wire on the anterior teeth. Next, Lidocaine 2% with 1:100,000 Epinephrine was infiltrated into the maxillary vestibule and the patient was given bilateral second division nerve blocks through the anterior palatine foramena. After adequate time had elapsed for hemostasis, an incision was made from the distal aspect of the maxillary right first molar tooth to the maxillary left first molar tooth approximately 5-8 mm superior to the mucogingival junction. The incision was carried through the mucosa, submucosa, and periosteum to bone. The entire maxilla was then degloved in subperiosteal fashion superiorly to the infraorbital nerves anteriorly to the nasal apertures, posteriorly exposing the maxillary buttress region. Posteriorly, the dissection was carried out in a tunneling type of fashion to the junction of the tuberosities and pterygoid plates bilaterally. Next, utilizing a Freer elevator, the nasal mucosa was separated from the superior aspect of the maxilla and a prominent anterior nasal spine was removed with rongueres. With proper retractors in place, osteotomy cuts were made through the lateral aspect of the maxilla above the apices of the teeth from the junction of the tuberosities and pterygoid plates anteriorly to the nasal aperture. This was done bilaterally. Following this, a guarded chisel was utilized to make osteotomy cuts through both medial walls of the maxillary sinuses and a nasal chisel was utilized to separate the nasal septum and vomer from the superior aspect of the maxilla. Next, an 8 mm curved osteotome was used to separate the tuberosities from the pterygoid plates bilaterally without incident and the entire maxilla was then downfractured with finger pressure. It was noted that there were a few small tears in the nasal mucosa in the anterior region and the left posterior region. These tears were repaired utilizing 4-0 plain gut interrupted sutures. It was noted that the fracture in the posterior regions were not at the junction of the pterygoid plates and tuberosities but had fractured through the previously extracted third molar sites. This was no problem. Following this, approximately 3 mm of medial sinus wall bilaterally was removed utilizing Kerrison rongueres and Hall drill. The septal area was also reduced with a Hall drill. The patient was then placed in intermaxillary fixation utilizing a previously made surgical splint and 25 gauge stainless steel wire after removal of the previously placed throat pack. The maxilla was then repositioned with care being taken to make sure that the condyles were in the fossas bilaterally. It was noted that the maxilla was touching bilaterally in the posterior regions so the superior aspect of the osteotomy cut was reduced 2-3 mm bilaterally. The maxilla was again repositioned and found to have good bony contact in the perinasal region and the buttress regions and the maxilla was then wired in place utilizing four transosseous 25 gauge stainless steel wires, two placed in the lateral piriform rim area, two placed in the zygomatic buttress areas. The surgical areas were irrigated and the soft tissues then reproximated with 4-0 Dexon suture in the horizontal mattress fashion. The patient was then awakened and taken to the recovery area intubated. Estimated blood loss was between 400 and 500 cc. At the termination of the procedure, all maxillary tissues were pink and viable.
If anyone else has operation reports, I would love to read them !
========
With the patient in the supine position and under satisfactory nasal tracheal anesthesia, she was prepped and draped in the usual fashion for a transoral procedure. The oropharynx was suctioned and a throat pack placed. Erich arch bars were then applied to the maxillary and mandibular arches utilizing 23 gauge stainless steel wire on the anterior teeth. Next, Lidocaine 2% with 1:100,000 Epinephrine was infiltrated into the maxillary vestibule and the patient was given bilateral second division nerve blocks through the anterior palatine foramena. After adequate time had elapsed for hemostasis, an incision was made from the distal aspect of the maxillary right first molar tooth to the maxillary left first molar tooth approximately 5-8 mm superior to the mucogingival junction. The incision was carried through the mucosa, submucosa, and periosteum to bone. The entire maxilla was then degloved in subperiosteal fashion superiorly to the infraorbital nerves anteriorly to the nasal apertures, posteriorly exposing the maxillary buttress region. Posteriorly, the dissection was carried out in a tunneling type of fashion to the junction of the tuberosities and pterygoid plates bilaterally. Next, utilizing a Freer elevator, the nasal mucosa was separated from the superior aspect of the maxilla and a prominent anterior nasal spine was removed with rongueres. With proper retractors in place, osteotomy cuts were made through the lateral aspect of the maxilla above the apices of the teeth from the junction of the tuberosities and pterygoid plates anteriorly to the nasal aperture. This was done bilaterally. Following this, a guarded chisel was utilized to make osteotomy cuts through both medial walls of the maxillary sinuses and a nasal chisel was utilized to separate the nasal septum and vomer from the superior aspect of the maxilla. Next, an 8 mm curved osteotome was used to separate the tuberosities from the pterygoid plates bilaterally without incident and the entire maxilla was then downfractured with finger pressure. It was noted that there were a few small tears in the nasal mucosa in the anterior region and the left posterior region. These tears were repaired utilizing 4-0 plain gut interrupted sutures. It was noted that the fracture in the posterior regions were not at the junction of the pterygoid plates and tuberosities but had fractured through the previously extracted third molar sites. This was no problem. Following this, approximately 3 mm of medial sinus wall bilaterally was removed utilizing Kerrison rongueres and Hall drill. The septal area was also reduced with a Hall drill. The patient was then placed in intermaxillary fixation utilizing a previously made surgical splint and 25 gauge stainless steel wire after removal of the previously placed throat pack. The maxilla was then repositioned with care being taken to make sure that the condyles were in the fossas bilaterally. It was noted that the maxilla was touching bilaterally in the posterior regions so the superior aspect of the osteotomy cut was reduced 2-3 mm bilaterally. The maxilla was again repositioned and found to have good bony contact in the perinasal region and the buttress regions and the maxilla was then wired in place utilizing four transosseous 25 gauge stainless steel wires, two placed in the lateral piriform rim area, two placed in the zygomatic buttress areas. The surgical areas were irrigated and the soft tissues then reproximated with 4-0 Dexon suture in the horizontal mattress fashion. The patient was then awakened and taken to the recovery area intubated. Estimated blood loss was between 400 and 500 cc. At the termination of the procedure, all maxillary tissues were pink and viable.
Still, it's nice that my bite is still closed ... if you read the studies, you'll see that a significant percentage of patients experience recurrence of the open bite. That's another reason I wanted to post, I wanted to let people know that there are some people who, long-term, have success. I have had *zero* complications from my surgery after all of these years. I would think this is reassuring to anyone who is facing the surgery or who has gone through it recently.