OSTEOTOMIA LEFORT I

PABLO EMILIO CORREA

CIRUJANO MAXILOFACIAL

ANATOMA

HISTORIA

Bernhard Rudolf Konrad von

Langenbeck
1859
Eliminacin
Plipos
nasofarngeos

David Williams Cheever

1867
Tratamiento de la
obstruccin nasal completa
y epistaxis recurrentes
como consecuencia de
tumores en nasofaringe

The origin of the Le Fort 1 maxillary osteotomy: Cheever' s operation Frank Moloney, MD,
DDS; and Philip Worthington, MD, DDS, Seattle J ORAL SURGERY VOL 39, OCTOBER 1981

Ren Le Fort
1901

Etude
exprimental sur
les fractures de
la machoire
suprieure

Peterson's principles of oral and maxillofacial surgery second edition

Martin Wassmund
1927

Describi por primera vez la

osteotoma Le Fort I para la
correccin de tercio medio
facial

. Ann Chir Plast Esthet 1994 Aug; 39 (4) :431-41.

[Todava hay indicaciones para la osteotoma de Wassmund?].
Boutault F , Paoli JR , Gasquet F .

Georg Axhausen
1934

Movilizacin total del

maxilar con la inmediata
reposicin, separacin
de la unin
pterigomaxilar

Karl Albert Max Schuchardt

1942

Osteotoma Le
Fort I en 2
estadios:

Separacin
pterygomaxilar

Traccin
externa
utilizada para
llevar hacia
adelante el
maxilar

Peterson's principles of oral and maxillofacial surgery second edition

Hugo Lorenz Obwegeser

1965

Sugiri la
completa
movilizacin del
maxilar sin
tensin

William H. Bell
1977

Nuevas tcnicas
para asegurar
aporte sanguneo
y evitar posibles
complicaciones

Peterson's principles of oral and maxillofacial surgery second edition

Estudio Pre quirrgico

Examen clnico
Estudio radiogrfico

Panormica
Ceflica
Cefalometra - Predicciones
Modelos Articulador Prediccin
Frula Quirrgica
Estudio Fotogrfico
Exmenes pre quirrgicos
Valoracin pre anestsica

OSTEOTOMA LE FORT

Osteotoma Le Fort I
Movimientos en
los 3 planos del
espacio
Posicin del
labio superior

Punta de la nariz

Base alar
ngulo de
columnela labial
Peterson's principles of oral and maxillofacial surgery second edition

Osteotoma Le Fort I

Pravin K. Patel,Michael V. Novia, The Surgical Tools: The LeFort

I,Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous
Genioplasty. Clin Plastic Surg 34 (2007) 447475

Esquemas de Osteotomas

Pravin K. Patel,Michael V. Novia, The Surgical Tools: The LeFort I,

Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous
Genioplasty. Clin Plastic Surg 34 (2007) 447475

Osteotoma Le Fort I

Pravin K. Patel,Michael V. Novia, The Surgical Tools: The LeFort

I,Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous
Genioplasty. Clin Plastic Surg 34 (2007) 447475

Variacin

Peterson's principles of oral and maxillofacial surgery second edition

Variacin

Osteotoma Le Fort Alta

Pravin K. Patel,Michael V. Novia, The Surgical Tools: The LeFort

I,Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous
Genioplasty. Clin Plastic Surg 34 (2007) 447475

Interposicin de Injerto

G.R. Hoffmana. The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla
Part 2. The influence of uncontrollable clinical variablesBritish Journal of Oral and
Maxillofacial Surgery (2004) 42, 226230

TCNICA QUIRRGICA

ANESTESIA GENERAL
INFILTRACIN

Pravin K. Patel. The Surgical Tools: The LeFort I, Bilateral Sagittal Split Osteotomy of the
Mandible, and the Osseous Genioplasty. Clin Plastic Surg 34 (2007) 447475

INCISIN

DISECCIN

TRAZADO DE CORTE

CORTE - Sierra

CORTE - Cincel

DOWN FRACTURE

DOWN FRACTURE

Pravin K. Patel. The Surgical Tools: The LeFort I, Bilateral Sagittal Split Osteotomy of the
Mandible, and the Osseous Genioplasty. Clin Plastic Surg 34 (2007) 447475

FIJACIN

Cincha Alar

Pravin K. Patel,Michael V. Novia, The Surgical Tools: The LeFort I, Bilateral Sagittal Split
Osteotomy of the Mandible, and the sseous Genioplasty. Clin Plastic Surg 34 (2007) 447475

SimPlant
Use of stereolithographic cutting guides in corrective (wedge)
Lefort I osteotomy. R. Seeberger et al. / British Journal of Oral and Maxillofacial
Surgery 49 (2011) e20e21

COMPLICACIONES

David E. Morris. Pitfalls in Orthognathic Surgery: Avoidance and Management of

ComplicationsClin Plastic Surg 34 (2007) e17e29

EXTRAORALES

SEMIRIGIDA

SUSPENSION
ESQUELETICA

INTERDENTAL

INTERMAXILAR
(tornillo)

Koichiro Ueki The Use of an Intermaxillary Fixation Screw for Mandibular Setback Surgery. J Oral Maxillofac Surg 65:1562-1568, 2007

ALAMBRADO

INTEROSEO
OSTEOSNTESIS

RIGIDA
PLACAS DE
TITANIO

REABSORBIBLES

TORNILLOS

 Aceptado
universalmente
Familiarizado
tcnica
Maleable
Pequeo
Resistente

Crecimiento
nios????
Migracin tornillo

Maleable
Palpar
Destellos
RADIOGRAFA

Alergnicos ??
Retiro?

PLACAS DE
TITANIO

Tercio
superior
0.6 espesor
Long 2-10mm

titanio

Tercio medio
0.6 espesor
Long 2-10mm
titanio

Dimetro 1.7 y 2.0 mm

Longitud 3-9, 11, 13, 15 mm

Tercio
inferior y
medio
0.6 espesor

Long 2-10mm
titanio

Dimetro 2.0 y 2.3 mm

Longitud 4-9, 11, 13, 15, 17, 19 mm

PLACAS DESLIZANTES

Espesor 0.7 mm
MODUS OSS 2.0

PLACAS DESLIZANTES

PLACAS DE
COMPRESION

TERCIO INFERIOR

ESPESOR 1.6mm

Zona
Deslizante

Espesor
Perfil

1.6 mm
1.5 mm

COMPRESION
DINAMICA

Baker S. Concepts and Techniques of Rigid Fixation. Fonseca RI y Col Oral and Maxilofacial Trauma. 1997

 No infeccin
No corrosin

No 2 ciruga
No palpacin
No destellos

 Costo
No re-esterilizacin
Fracturas material
Estudios
Reabsorcin completa?

TIPOS

Polidioxanona (PDO)
Poligliconato
Ac Poliglicolico (PGA)
Ac Polilactico (PLLA)
Copolimero PGA-PLLA
(Lactosorb)

Turvey T. The use of self-Reinforced Biodegradable Bone Plates ans Screws in Orthognatic Surgery. J Oral
Maxillofac Surg 60: 59-65, 2002

AC POLIGLICOLICO (PGA)

 Ac Polilactico (PLLA)

COPOLIMERO PGA - PLLA

Nureddin Ashammakhi. Successful Use of Biosorb Osteofixation Devices in 165 Cranial and Maxillofacial Cases: A multicenter Report. The Journal
Of Craniofacial Surgery / Volume 15, Number 4 July 2004

Barry L. use a resorbable plates and screws in pediatric facial fractures. J Oral Maxillofacial Surg 63: 385-391, 2005

GRACIAS