Maxillary osteotomy (Le Fort I)
The Le Fort I osteotomy gently mobilises the upper jaw, the bone structure that holds the upper dental arch and the palate, to correct its position in all three dimensions: advancement, impaction (raising), down-grafting (lowering), recentring or rotation. It corrects a gummy smile, an open bite, asymmetry and a receding upper jaw. It is frequently combined with a mandibular osteotomy.
Indications
Gummy smile: too much gum visible when smiling, vertical maxillary excess → impaction.
Open bite: the upper and lower teeth do not touch at the front → posterior impaction or rotation.
Class III (lower teeth in front of the upper teeth, "prognathic" appearance): most often due to a receding maxilla → maxillary advancement, rather than a mandibular setback.
Upper teeth barely visible when smiling, "short" face → down-grafting.
Asymmetry of the occlusal plane, tilted smile line → recentring and levelling.
Expected benefits
A normal relationship between the teeth and normal chewing, preventing tooth wear, loosening of the teeth and jaw joint disorders.
A lower risk of sleep apnoea.
A normal relationship between the jaws when the discrepancy makes a dental prosthesis impossible.
A harmonious face, from the front and in profile.
Principle
The incision is inside the mouth, on the gum above the upper teeth: invisible from the outside. The maxilla is cut horizontally above the roots, at the level of the classic Le Fort I fracture line, gently separated from the rest of the facial bones, then repositioned according to the 3D-printed surgical splint and fixed with four titanium mini-plates.
Specific points
Duration: about 1 h 30 when not combined with a mandibular osteotomy.
Hospital stay: 1 night.
Swelling mainly in the middle third of the face and the upper lip; bruising around the eyes is possible.
Blocked nose and moderate nosebleeds during the first few days: normal. Saline spray, do not blow your nose for 3 weeks, sneeze with the mouth open.
Numbness of the upper lip, side of the nose, upper teeth and palate: recovers in a few weeks to a few months.
A slight change in the base of the nose (widening of the nostrils) is anticipated in the planning and corrected by a specific suture at the end of the operation.
The upper wisdom teeth can be removed during the osteotomy.
Sinusitis is possible after the operation; it usually resolves with antibiotics.
Recovery
Guide to the first 6 weeks on the orthognathic surgery page. Specific points: nasal care, mandibular mobilisation and lip contraction exercises, maxillofacial physiotherapy from week 3 if needed.
FAQ
Will my nose change?
Slightly, especially after an advancement or impaction: the tip may lift and the nostrils widen a little. These effects are taken into account in the planning.
Is a gummy smile corrected permanently?
Yes, maxillary impaction is the only stable treatment for a gummy smile of skeletal origin.
Can the maxilla be operated on alone?
Yes, when the mandible is well positioned.
Do the plates stay?
Yes, under the gum, invisible, generally for life; removal possible from 6 months if they cause discomfort.