Le Fort III Osteotomy and Variations

In 1942, Gillies performed a Le Fort III reosteotomy for the first time on a patient with a Le Fort III fracture that had healed in malposition. Similar to the maxillary osteotomies, years passed before Tessier took up this technique in 1967 and separated the entire midface (high-level midface osteotomy) from the skull base and displaced it anteriorly or inferiorly, changing not only occlusal discrepancies but also the position of the bulbi and the nasal skeleton. This also resulted in a significant widening of the posterior airway. In bimaxillary corrections of today, the mandibular osteotomy is rarely performed simultaneously with a LeFort III osteotomy. This is due to the fact that the high-level midface osteotomies are usually performed at an early age and further growth must be awaited for any necessary correction at the LeFort I level or even in the mandible. In adulthood, a LeFort III osteotomy may be indicated in cases of malignant exophthalmia, for example, in which a setback correction of the mandible must be performed at the same time in order to correct the occlusion.