Le Fort I

Often osteotomies (eg. Le Fort I, single or multiple piece) may be used to correct posttraumatic malposition of the maxilla. The procedure is performed as described in the orthognathic section.

Note: It must be taken into consideration that due to scarring and callus formation, mobilization may be more difficult than in orthognathic patients.

After mobilization of the maxilla, scar tissues and excess bone may need to be trimmed away to allow for maxillary repositioning and/or narrowing.

The masticatory system may compensate for small imperfections in the mandible. However, patients with a slight malocclusion can benefit from occlusal adjustments to obtain a more symmetric and stable bite.

Slight residual malocclusions in dentate patients may be corrected by orthodontic therapy or...

…occlusal adjustments.

In patients with prosthetic appliances, new prostheses can be fabricated to accommodate the malocclusion.

• Analgesia as necessary
• Antibiotics (many surgeons use perioperative antibiotics). There is no clear advantage of any one antibiotic but evidence supports their use for 24h. The spectrum should be according to the existing bacterial flora, especially in the combined intra oral and paranasal sinuses.
• Steroids may help with postoperative edema.
• Regular perioral and oral wound care has to include disinfectant mouth rinse, lip care, etc.
• Antibiotic ointment is used on skin incision (when indicated) for 72 hours.

Diet depends on the correction method.

For patients with free flap reconstruction of the maxilla, a feeding tube is placed during sugery allowing the patient to be kept nil per os for 5-7 days. If issues develop with velopharyngeal insufficiency or dysphagia, assessment by a speech and swallowing rehabilitation specialist may be indicated. When the lateral nasal wall is reconstructed, especially when a bulky soft tissue flap is used, the nasal airway should be stented with gauze packing or a merocel sponge for five days.

Patients with intraoral incisions and/or wounds must be instructed in appropriate oral hygiene procedures. A soft toothbrush (dipped in warm water to make it softer) should be used to clean the surfaces of the teeth. Chlorhexidine oral rinses should be prescribed and used at least 3 times a day to help sanitize the mouth. For larger debris, a 1:1 mixture of hydrogen peroxide/chlorhexidine can be used. The bubbling action of the hydrogen peroxide helps remove debris.

Typically the patients are seen in clinical follow-up one week after discharge, and then on a weekly basis until such time the clinician determines that less frequent follow ups are needed.