A Case of Le Fort Ⅰ Osteotomy on a Patient with Malunited Panfacial Fracture

Abstract

Panfacial fracture is often accompanied by soft tis-sue injuries and loss of bony structures. Because of the lack of normative anatomical structure, it is difficult to reduce and fix to the former state. Moreover, it could lead to post-traumatic deformities and dysfunctions. If appropriate primary treatment is not performed, it can cause abnormal bone healing and scarring of soft tissue. Therefore, orthognathic surgery is frequently performed for jaw deformity due to malunited panfacial fracture. The present case was a 24-year-old man who suffered panfacial fracture in a traffic accident. The maxilla and mandible were openly reduced and internally fixed at another hospital; other fractures in this region were conservatively managed. However, malocclusion and facial deformity caused by malunion were seen and nine months later he was referred to our hospital with a chief complaint of concave profile and occlusal reconstruction. We aimed to improve his concave profile and decided to perform orthognathic surgery. Intraoral findings showed Angle Class Ⅰ and Class Ⅲ molar relations on the right and left, respectively. Cephalometric analysis revealed SNA 72.0°, SNB 77.7°, ANB−5.7° and A-B plane 7.4°. He was diagnosed as maxillary retrusion associated with malunited panfacial fracture. In order to achieve func-tional occlusion, two surgical plans were proposed: 5 mm advance by Le Fort Ⅰ osteotomy or 5 mm setback by bi-lateral sagittal split ramus osteotomy. We performed 3D virtual planning using software, which showed that Le Fort Ⅰ osteotomy was appropriate compared with bilat-eral sagittal split ramus osteotomy. We informed him of this surgical plan with 3D simulation data, and he agreed to it. It was expected to be difficult to perform normal osteotomy because of bone defect and malunion, so we constructed a 3D stereolithographic model and carried out surgery on the model. Finally, we performed orthognathic surgery as planned and safely. The postoperative course has been uneventful since then. It is thought that these surgical procedures may be effective for patients with malunited panfacial fracture, and that preoperative management led to good results.