顎変形症の標準手術 － Le Fort I 型骨切り術－

Abstract

Othognathic surgery for jaw deformities are most frequently performed in Japan. Regarding those procedures, Le Fort I osteotomy and anterior maxillary alveolar osteotomy in the maxilla, and sagittal split ramus osteotomy, intraoral vertical ramus osteotomy, anterior mandibular alveolar osteotomy, and genioplasty in the mandibule are selected singly or combined based on cases. Among these orthgnathic surgeries, Le Fort I osteotomy is a typical surgical procedure, as well as sagittal split ramus osteotomy. Although the designing of osteotomy lines in Le Fort I osteotomy is simple, this surgical procedure is apt to be regarded as difficult, due to other risk factors in comparison with mandibular osteotomy, such as difficulty in the repositioning of bone segment, complexity of the maxillary bone structure, bleeding, surgical invasion of the nasal cavity and paranasal sinus, and postoperative changes in the nasal base morphology. However, regarding surgical treatment for jaw deformities, Le Fort I osteotomy is considered to be a surgical procedure which we should master, as well as sagittal split ramus osteotomy.Basically, orthognathic surgeries involve subperiosteal surgical manipulation, and it is simply summarized that Le Fort I osteotomy should also be carefully performed without injuring the periosteum. In order to achieve this, it is necessary to accumulate experience, sufficiently understanding the basic factors to safely perform Le Fort I osteotomy. This manuscript outlines the major points in the surgical procedure of Le Fort I osteotomy.