Segmental Osteotomies in the Maxilla

The last five decades have seen decisive advances in orthognathic surgery in terms of surgical techniques and outcomes in the treatment of dysgnathic maxillofacial malocclusions and deformities. However, despite brilliant technical innovations, the basic surgical principles have remained unchanged. The most common midface osteotomy techniques currently used to correct growth-related sagittal, vertical, and transverse deviations, as in syndromal and nonsyndromal maldevelopments, in various modifications, involve premaxillary segmental osteotomies and variably designed total Le Fort osteotomies in the Le Fort I, II, and III levels of the jaws. Although the monobloc osteotomies described by Tessier (Ann Chir Plast 12:273 1967) are also part of corrective surgery of the face, they are not part of standard orthognathic surgical procedures. Osteotomies must be performed in a safe way and preferably by intraoral approach to avoid scars on the face and at the same time provide adequate exposure to the skeleton. Essential structures must be preserved, the airway must remain free, and provision for appropriate nutrition postoperatively should be considered.