What is Le Fort II Osteotomy

Le Fort II osteotomy is a procedure done to the upper part of the jaw (maxilla) that corrects misalignment of the upper and lower teeth (malocclusion), including the tip of the nose.

This procedure may be done to repair facial deformities caused by Crouzon, Pfeiffer, and Apert syndromes. A person with one of these syndromes is born with underdeveloped facial bones, which may lead to a condition in which breathing pauses or becomes shallow during sleep (sleep apnea).

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Injuries and damage to the nerves in your face.
• Accidental fractures of other facial bones.
• Damage to your nose, eyes, tear ducts, or the bones that surround your eyes.
• Injury to your teeth or gums.
• Your jaw moving back into its old position.
• Injury to your spinal cord, which can lead to leaking of cerebral spinal fluid. This is rare.

What happens before the procedure?

Dental care

Follow instructions from your health care provider regarding dental hygiene and orthodontic management, which may include:

• Teeth cleaning.
• Reducing inflamed gums and gingivitis.
• Treating cavities and periodontal disease.
• Having dental models made.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider asks you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You may be fitted with a splint to wear in the weeks after your surgery.
• You may need to have the following done to help your surgeon plan for the surgery:
  • Detailed photographs.
  • X-rays.
  • CT scans.
  • Other digital face mapping procedures.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• You will have a tube placed in your nose to help you breathe throughout the surgery.
• Your surgeon will make cuts (incisions) inside your mouth or on your head, or both.
• Your surgeon will move your upper jaw, face, and nose bones into the preferred position in relation to your lower teeth.
• Your surgeon will use small plates and screws to anchor your jaw in place in its new location. You may have your upper and lower jaws wired together temporarily.
• If there are any gaps after your jaw and nose have been repositioned, bone grafts may be needed to fill these in. The bone grafts are usually taken from your hip.
• Tubes to drain accumulated fluid will be placed into the scalp incision before the incision is closed.
• Your incisions will be closed with stitches (sutures) or staples.
• Your scalp incision may be covered with a bandage (dressing).
• You may have a device placed during surgery to help with bone movement and growth (external distraction device).
• A tube (nasogastric tube or NG tube) will be placed through your nose and into your stomach to drain fluid and prevent nausea.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• Do not drive for 24 hours if you were given a sedative.
• You will be given medicine for pain as needed.
• The head of your bed will be kept at an upright angle (elevated) to help with swelling. Ice may also be applied to your face to help with swelling.
• You will sit up and walk as soon as it is safe. This will help decrease swelling and improve the function of your lungs.
• When the NG tube is removed, you will be given a liquid diet. Then, you will be advanced to a very soft diet that you do not have to chew.
• You may have to wear a dental splint or external distraction device to keep your upper and lower jaws in proper alignment while healing begins.
• You may be given antibiotics to prevent infection.

Le Fort II Osteotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• A sore throat from the breathing tube.
• Swelling and bruising of your face.
• Pain.

Follow these instructions at home:

Swelling and pain management

• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• You may be asked to sleep with the head of your bed at an upright angle (elevated) or to sleep on several pillows to help with swelling.
• Walk several times a day or as told by your health care provider. This will help decrease swelling and improve the function of your lungs.

Medicines

• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you were given a medicine to help you relax (sedative).

Activity

• Do not exercise until your health care provider says it is okay.
• You may be given some jaw exercises to help improve mobility and strength. Do them as told by your health care provider.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Follow instructions from your health care provider about diet. At first, you will be kept on a liquid diet. Then, you will advance to a soft diet that is easy to chew and swallow (mechanical diet) for 4–6 weeks. When your jaw has healed, you will return to your normal diet.
• You may have to wear a splint or a device to help with bone movement and growth (external distraction device) to keep your upper and lower jaws aligned while healing. You may need to wear the splint or device for as long as 4–6 weeks after the surgery. Follow instructions from your health care provider about how to care for the splint or external distraction device.
• You may have to see an orthodontist to make sure your teeth are properly aligned.
• Follow the oral hygiene instructions given by your health care providers.
• Keep all follow-up visits as told by your health care providers. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision area.
• You have more fluid or blood coming from your incision area.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision area.
• Your pain medicine does not help.
• You vomit for more than 2 days.
• You cannot eat or drink.
• You have a new cough.
• You have a fever.

Get help right away if:

• You have new, severe pain in the surgical area.
• You have trouble breathing.
• You have chest pain.