Le Fort I osteotomy: Definition, Uses, and Clinical Overview

Definition (What it is) of Le Fort I osteotomy

Le Fort I osteotomy is a surgical procedure that cuts and repositions the upper jaw (the maxilla).
It is used to correct bite problems and facial imbalance by moving the maxilla in a controlled way.
It is commonly performed in orthognathic (jaw) surgery for functional correction and facial harmony.
It can be part of reconstructive care after trauma, congenital conditions, or tumor-related surgery.

Why Le Fort I osteotomy used (Purpose / benefits)

Le Fort I osteotomy is used when the position or shape of the upper jaw contributes to problems with how the teeth fit together (occlusion), how the face looks in profile or front view, and how certain functions work.

From a functional standpoint, repositioning the maxilla can help align the dental arches so chewing forces distribute more evenly. It may also be used to address speech-related issues that stem from jaw relationships, and in selected cases it can change the internal nasal anatomy and airflow by altering the skeletal framework that supports the nose and nasal floor. In multidisciplinary cleft care, it may be used to bring a retruded (underdeveloped) upper jaw forward to improve bite and facial balance.

From an aesthetic (cosmetic) standpoint, moving the maxilla can influence midface projection, the relationship of the upper lip to the teeth, facial symmetry, and overall facial proportions. These visual changes are not “one-size-fits-all”; the aesthetic effect depends on the direction and magnitude of the jaw movement and the patient’s soft-tissue anatomy.

In reconstructive contexts, Le Fort I osteotomy can help restore skeletal position after injury or address growth-related discrepancies. It may also be used to improve the platform for dental rehabilitation in complex cases, such as when combined with bone grafting or other jaw procedures.

Indications (When clinicians use it)

Typical scenarios where clinicians may consider Le Fort I osteotomy include:

• Skeletal malocclusion where the upper jaw is too far back (maxillary retrusion) or too far forward (maxillary protrusion) relative to the lower jaw
• Open bite, especially when related to vertical maxillary excess or skeletal patterns not correctable with orthodontics alone
• Crossbite due to transverse (width) discrepancies of the maxilla, sometimes with segmental techniques
• Facial asymmetry where maxillary position contributes to a canted smile or uneven midface proportions
• Cleft lip/palate–related maxillary hypoplasia requiring skeletal advancement (often coordinated with a cleft team)
• Post-traumatic deformity or malunion affecting maxillary position
• Preparation for combined jaw surgery (bimaxillary surgery) when both upper and lower jaws contribute to the bite discrepancy
• Selected reconstructive plans where maxillary repositioning supports dental rehabilitation and facial balance

Contraindications / when it’s NOT ideal

Le Fort I osteotomy is not suitable for every patient or every type of bite concern. Situations where it may be avoided, delayed, or replaced by another approach can include:

• Medical conditions that make major surgery or general anesthesia higher risk (varies by clinician and case)
• Uncontrolled systemic disease that impairs healing (for example, poorly controlled metabolic conditions)
• Active oral or sinus infection, or untreated dental/periodontal disease that could compromise stability
• Severe smoking or nicotine exposure that may increase healing complications (risk varies by clinician and case)
• Bone quality or anatomy that makes fixation and stable healing difficult (assessment is individualized)
• Primary problems that are dental (tooth-position) rather than skeletal, where orthodontics alone may be more appropriate
• Patients who cannot participate in required follow-up, postoperative diet modifications, or orthodontic coordination
• Expectations centered on a specific cosmetic outcome that is not realistically tied to skeletal movement (expectations should be aligned during planning)

In some cases, clinicians may favor alternatives such as orthodontic camouflage, mandibular surgery alone, distraction techniques, or different osteotomies depending on the anatomy and goals.

How Le Fort I osteotomy works (Technique / mechanism)

Le Fort I osteotomy is a surgical procedure, not a minimally invasive or non-surgical treatment. There is no non-surgical equivalent that can reposition the upper jaw bone in the same way; non-surgical options may camouflage appearance but do not move the maxilla.

At a high level, the mechanism is repositioning: the surgeon separates the maxilla from the surrounding facial bones at a planned level, moves it into a new position, and stabilizes it so the bone can heal in that position.

Typical elements of the technique include:

• Incisions: Most commonly inside the mouth (intraoral), which helps avoid visible facial scars in many cases.
• Bone cuts (osteotomies): Performed with surgical instruments such as oscillating saws and osteotomes, following a preplanned pattern.
• Mobilization and repositioning: The maxilla is moved forward, backward, up, down, widened, or rotated depending on the treatment plan.
• Fixation: Small plates and screws are commonly used to hold the bone segments stable during healing. The exact hardware and configuration vary by surgeon preference and case needs.
• Guidance tools: Surgical splints, bite registrations, and increasingly virtual surgical planning (3D planning) may be used to transfer the plan to the operating room (varies by clinician and case).

Because the upper jaw relates closely to the nasal cavity, teeth, and midface soft tissues, the procedure is typically coordinated with orthodontic planning and, when needed, additional facial or nasal procedures.

Le Fort I osteotomy Procedure overview (How it’s performed)

A simplified, general workflow often looks like this:

1. Consultation
   A clinician evaluates the bite, facial proportions, symptoms (such as chewing difficulty), and patient goals. This often involves both a surgeon and an orthodontist.

2. Assessment and planning
   Planning may include photographs, dental impressions or scans, and imaging (commonly X-rays and/or CT-based planning). The team determines how the upper jaw needs to move to meet functional and aesthetic objectives.

3. Prep/anesthesia
   Le Fort I osteotomy is most commonly performed under general anesthesia. Preoperative preparation can include orthodontic appliances, instructions for perioperative care, and coordinated surgical planning (details vary by clinician and case).

4. Procedure
   The surgeon makes intraoral incisions, performs the planned osteotomy cuts, mobilizes the maxilla, and repositions it according to the surgical plan. Fixation with plates and screws is typically used to stabilize the new position.

5. Closure/dressing
   The intraoral incision is closed with sutures. Depending on the plan, guiding elastics, splints, or other supportive measures may be used. External dressings are not always necessary.

6. Recovery
   Early recovery focuses on swelling control, oral hygiene, nutrition, and follow-up. Bone healing and orthodontic “finishing” occur over time, with the overall timeline varying by anatomy, movement size, and clinician protocol.

Types / variations

Clinicians describe variations of Le Fort I osteotomy based on how the maxilla is moved and whether it is divided into segments.

Common variations include:

• Single-piece (one-piece) Le Fort I osteotomy
  The maxilla is moved as one unit. This is often used for forward/backward and vertical changes, and for correcting cant (tilt) when feasible without segmentation.

• Segmental Le Fort I osteotomy
  The maxilla is divided into two or more segments to address width (transverse) discrepancies or complex dental arch relationships. Segmenting can allow targeted expansion or alignment changes, but planning and stability considerations differ by case.

• Directional movement variations

• Advancement: Moving the maxilla forward to address maxillary retrusion and improve overjet relationships.
• Setback: Moving the maxilla backward in selected cases (less common than advancement in many practices).
• Impaction: Moving the maxilla upward, often used for vertical maxillary excess or to help close an open bite.
• Down-grafting: Moving the maxilla downward to increase vertical height (often with added support such as grafting when needed; varies by clinician and case).

• Rotation/cant correction: Adjusting the tilt of the maxilla to address asymmetry or a canted smile.

• With or without bone grafting
  Bone grafting may be used in selected movements or gaps to support stability (varies by clinician and case). Graft source and material depend on surgeon preference and clinical situation.

• Isolated maxillary surgery vs combined jaw surgery
  Le Fort I osteotomy can be done alone or combined with procedures such as mandibular sagittal split osteotomy and/or genioplasty to harmonize the bite and facial proportions.

• Anesthesia choices
  Most commonly performed under general anesthesia due to the complexity and airway considerations. Local anesthesia alone is typically not used for full Le Fort I osteotomy.

Pros and cons of Le Fort I osteotomy

Pros:

• Can address skeletal bite problems that orthodontics alone cannot correct
• Allows three-dimensional repositioning of the upper jaw (forward/back, up/down, rotation, and sometimes widening)
• May improve facial balance by changing midface projection and upper lip support (effect varies by anatomy and movement)
• Often uses intraoral incisions, which may limit visible scarring on the face
• Commonly integrates with orthodontic treatment for coordinated functional and aesthetic planning
• Can be combined with other jaw procedures when both jaws contribute to the discrepancy

Cons:

• Major surgical procedure requiring anesthesia and a structured recovery period
• Swelling, bruising, and temporary functional limitations are common during early healing
• Risks can include bleeding, infection, sinus/nasal changes, dental/root issues, and sensory changes (risk profile varies by clinician and case)
• May require orthodontic treatment before and after surgery, extending the overall timeline
• Fixation hardware is typically used; in some cases hardware may be palpable or later removed (varies by clinician and case)
• Precise planning is critical; revisions can be complex if goals are not met or if healing differs from expectations

Aftercare & longevity

The structural changes from Le Fort I osteotomy are intended to be long-lasting because the upper jaw bone heals in its new position. However, “longevity” in real-world terms depends on multiple factors, including bone healing, dental stability, and how soft tissues adapt.

Factors that can influence durability and long-term satisfaction include:

• Surgical planning and fixation strategy: The direction and magnitude of movement, segmenting choices, and fixation method can affect stability (varies by clinician and case).
• Bone healing biology: Individual healing capacity, general health, and nutrition can affect recovery.
• Orthodontic coordination and retention: Postoperative orthodontics and retainers help maintain the corrected bite relationship.
• Oral hygiene and periodontal health: Healthy gums and teeth support long-term occlusal stability.
• Smoking/nicotine exposure: Nicotine can affect healing and complication risk, which may indirectly influence long-term outcomes.
• Follow-up and monitoring: Regular follow-up helps identify issues such as bite shifts, hardware irritation, or sinus symptoms.
• Lifestyle and parafunction: Habits like clenching or grinding can affect teeth and jaw comfort over time; impact varies by individual.

Recovery experiences differ widely. Swelling often changes for weeks, while bone healing and orthodontic refinement can take longer. Clinicians typically provide individualized aftercare instructions, dietary progression, and timelines based on the case.

Alternatives / comparisons

The “best” alternative depends on whether the primary problem is skeletal (jaw position), dental (tooth position), or soft tissue (appearance without bite dysfunction). Common comparisons include:

• Orthodontics alone (braces or aligners)
  Orthodontics can move teeth within the existing jawbones. It may be appropriate when the jaw relationship is acceptable and the issue is mainly crowding or tooth inclination. It generally cannot correct a significant skeletal discrepancy the way Le Fort I osteotomy can.

• Orthodontic camouflage vs skeletal correction
  Camouflage strategies may tip teeth to improve how the bite fits, sometimes at the expense of ideal tooth angulation. Le Fort I osteotomy targets the underlying skeletal relationship rather than compensating with tooth positions.

• Mandibular surgery alone
  If the upper jaw is acceptable and the lower jaw is the main driver of the bite problem, clinicians may choose a lower-jaw procedure without moving the maxilla. In other cases, moving only one jaw may not achieve the desired balance.

• Bimaxillary (double jaw) surgery
  When both jaws contribute to the discrepancy—or when facial balance goals require it—Le Fort I osteotomy may be combined with mandibular surgery. This increases complexity but may improve overall harmony in selected cases.

• Palatal expansion techniques (orthodontic or surgical-assisted)
  For transverse deficiency (narrow upper jaw), expansion-focused approaches may be considered. Segmental Le Fort I is one option; other methods exist and selection varies by age, anatomy, and clinician preference.

• Distraction osteogenesis
  In some reconstructive or large-movement situations, gradual bone movement with distraction devices may be used. This approach differs in timeline and hardware needs and is chosen case-by-case.

• Aesthetic-only camouflage (fillers or implants)
  Injectable fillers or midface implants may change contour and projection but do not correct occlusion. They can sometimes complement jaw surgery planning, but they are not substitutes for skeletal repositioning when bite function is the main issue.

Common questions (FAQ) of Le Fort I osteotomy

Q: Is Le Fort I osteotomy painful?
Discomfort is expected after major jaw surgery, especially in the first days to weeks, but the experience varies by individual and pain-control approach. Many patients describe pressure, congestion-like sensations, and soreness rather than sharp pain. Pain management protocols differ by clinician and case.

Q: How long is the downtime after Le Fort I osteotomy?
Downtime varies by the extent of movement, whether other jaw procedures are done at the same time, and the type of work or school demands. Swelling and fatigue are common early on, and many people plan for a recovery period before returning to full activities. Your clinician’s timeline will reflect your specific surgery and healing.

Q: Will there be visible scarring?
In many cases, incisions are made inside the mouth, which helps avoid visible facial scars. If additional procedures are performed or specific access is needed, external incisions may be used in rare situations. Scar appearance and healing vary by person and technique.

Q: What kind of anesthesia is used?
Le Fort I osteotomy is most commonly performed under general anesthesia. This allows airway control and patient comfort during complex skeletal work. The anesthesia plan is determined by the surgical team and anesthesiology based on health status and procedure scope.

Q: How much does Le Fort I osteotomy cost?
Cost varies widely by region, facility setting, surgeon experience, anesthesia fees, imaging/planning, hospital stay, and whether it is performed for functional, reconstructive, or cosmetic goals. Insurance coverage and documentation requirements also vary. A formal estimate usually requires an in-person evaluation and coordinated orthodontic plan.

Q: How long do the results last?
Bone repositioning is intended to be durable once healing is complete, but long-term stability depends on factors like movement size/direction, fixation, orthodontic retention, and individual healing. Minor bite changes can occur over time in some patients. Longevity and stability vary by clinician and case.

Q: Is Le Fort I osteotomy safe?
All surgery carries risks, and jaw surgery has specific considerations involving bleeding, infection, dental structures, sinus/nasal anatomy, and nerve-related sensations. Safety is influenced by patient health, surgical planning, and the experience of the care team. A surgeon typically reviews individualized risks during consent.

Q: Will my nose or breathing change after surgery?
Because the maxilla forms part of the nasal base and floor, changes in nasal shape or airflow can occur in some cases. The direction of jaw movement and any additional nasal maneuvers can influence this. The degree and desirability of these changes vary by anatomy and surgical plan.

Q: Will I have numbness in my face or teeth?
Temporary numbness or altered sensation can happen due to swelling and proximity to nerves, particularly in the upper lip, cheeks, and gums. Sensory recovery patterns vary, and some changes may last longer than others. Your surgeon can explain what is more typical for the planned movements.

Q: Will I need braces before or after Le Fort I osteotomy?
Often, yes—orthodontic treatment is commonly coordinated to align teeth so the jaws can be repositioned accurately and the final bite can be refined afterward. Some treatment plans use different sequencing strategies, depending on case goals and clinician preference. The exact timeline varies by clinician and case.