Clinical Anatomy and the Le Fort Osteotomies

Bernhard von Langenbeck from Berlin performed the first Le Fort I osteotomy in 1859. A few years later, in 1867, Cheever removed a nasopharyngeal tumor by maxillary osteotomy using the first total maxillary downfracture method. Moloney and Worthington (J Oral Surg 39:1278–82, 1981) and Wassmund (Lehrbuch der praktischen Chirurgie des Mundes und der Kiefer, Vol. 1, 1935) performed several corrective procedures with maxillary osteotomies but without total maxillary mobilization. In 1927, he described subtotal mobilization after total maxillary osteotomy (Wassmund, Lehrbuch der praktischen Chirurgie des Mundes und der Kiefer, Vol. 1, 1935). It was Axhausen who finally risked the total mobilization of the maxilla in 1934 and 1936. William Bell introduced total maxillary osteotomy as a clinically safe method in OMF surgery since 1975 (Bell, J Oral Surg 27:249–55, 1969; Bell et al., J Oral Surg 33:253–60, 1975; Bell et al., Surgical correction of dentofacial deformities, Vol. 1–3, Saunders, 1980; Bell and Jacobs, J Maxillofac Surg 8:84–94, 1980; Moloney and Worthington, J Oral Surg 39:1278–82, 1981; Reuther, Mund- Kiefer- und Gesichtschirurgie 4(7):S237–8, 2000). The subtotal osteotomy and multiple segmentation of the maxilla according to Krüger (Krüger, Fortschr Kiefer-Gesichtschir 18:211–3, 1974) and Wolford and Epker (1975), described in the same developmental phase of OMF surgery, found few supporters because of the technically difficult surgical method and delayed bone healing. Obwegeser described osteotomy and relocation of the maxilla in 1965 and simultaneous bimaxillary osteotomy for correction of dysgnathia in 1970 (Obwegeser, SSO Schweiz Monatsschr Zahnheilkd 75:365–71, 1965; Obwegeser, Schweizerische Monatsschrift für Zahnheilkunde. 80:347–56, 1970). Today, the Le Fort I osteotomy is a standard procedure for the correction of maxillary or bimaxillary malocclusion. The downfracture method as it is used today was mainly studied and described by Bell (Bell et al. Int J Adult Orthodon Orthognath Surg 3:23–52, 1988; Bell, Modern practice in orthognathic and reconstructive surgery, Philadelphia: WB Saunders, 1992; Obwegeser, Plast Reconstr Surg. 43:351–65, 1969; Spiessl, New concepts in maxillofacial bone surgery. Springer, Berlin, Heidelberg, 1976).