Orthognathic Surgery for the Maxilla-LeFort I and Anterior Maxillary Osteotomy

Abstract The chapter reviews the history and technique of maxillary orthognathic surgical procedures and highlights the sequence of bimaxillary surgery. A maxillary surgical procedure and its modification can be employed to correct skeletal deformities of the maxilla. With presently available surgical techniques, the maxilla may be independently repositioned in three dimensions. Segmentalization of the maxilla in turn allows repositioning different portions in different three dimensional planes, when done under direct vision. The changes in the position of the maxilla also causes soft tissue changes of the lips, cheeks, and nose. Changes in the nasal complex after orthognathic surgery, with the exception of nasal width, are complicated, and cannot be predicted. Having listed a general guide, the authors reiterate that no dogma should be given regarding the sequence of maxillary or mandibular surgery. Any surgical decision must be made after in-depth planning, preparation, and flexibility. If this is done, sequencing will follow logically. The chapter also includes key considerations in orthognathic surgery viz., adjustment to the base of the Nose and ANS; effect of changing the inclination (slope) of the osteotomy cut; impacted / erupted wisdom teeth; preoperative/intraoperative difficulties and proper positioning. An in-depth account of nutritional support and dealing with complications rounds off the discussion.