Upper Jaw Surgery : Le Fort 1 Maxillary Osteotomy
Why do upper jaw surgery?
The upper jaw can be moved forward to improve the upper lip and midfacial support and correct a negative underbite. The upper jaw can also be impacted or moved upwards to reduce a gummy smile. It can also be rotated to correct asymmetry. The upper jaw can also be impacted at the back to allow the lower jaw to rotate upwards to close an open bite of the front teeth.
How is upper jaw surgery done?
Incisions are made in the gumline under the upper lip. There are no skin incisions and no scarring. The bone in the upper jaw is very thin and can be cut with a micro-saw blade from just under the nose all the way back to behind the last molar teeth. The upper jaw can then be moved to the new planned position. The movements have been done in the laboratory prior to surgery and surgical splints created. The surgical splint is then placed between the teeth and the jaws temporarily wired together using the surgical hooks placed on the braces into the new planned position and new bite. We now have the new position and the upper jaw is then fixated to this position using titanium mini-plates and mini-screws. There is usually 4 miniplates with 4 holes per plate and each plate is precisely bent and shaped to fit over the bone to hold the upper jaw into the new position. The wires are then released and the jaws are no longer wired together as the plates/screws are now maintaining the new position. The plates and screws are biocompatible and can stay indefinitely. They do not react with metal detectors and studies have shown titanium to be inert and integrate well with bone. Light dental elastics are placed between the teeth in the immediate post-operative period and patients are later taught to change the elastics daily and these can be removed during eating and cleaning of teeth.
How much pain and length of recovery?
Most patients worry about the pain after surgery however, the pain and discomfort is quite manageable. During surgery, a long-acting local anaesthetic is given so that patients do not wake up with much pain. Patients are connected to a drip attached to an automatic pain medication dispenser which they can activate by pressing a button. This is removed once patients no longer are using it usually in 48 hrs after which pain tablets such as Nurofen or Panadeine Forte are sufficient.
What are the risks and complications?
Risks include possible bleeding requiring possible blood transfusion, infection requiring antibiotics and further treatment, relapse of the bite that may require secondary surgery to adjust the plates/screws or additional orthodontic treatment, exposure of the plates/screws in future. There is small risk of numbness of the skin of the lip and cheek but unlike lower jaw surgery this rarely occurs and if so, is unlikely to be permanent.