A modified minimally invasive Le Fort I approach allowing four-point fixation osteosynthesis using lateral punctiform incisions

Surgical techniques in orthognathic surgery have recently evolved and now tend towards soft-tissue-preserving approaches. The concept of minimally invasive Le Fort I osteotomy and down-fracture is interesting, as it preserves almost all paranasal and upper-lip musculature. It has already been described with a four-point fixation on the canine and zygomatic buttress pillars, depending on the mucosal incision length and plate type. This article proposes an alternative technique, respecting the concept of minimally invasive surgery, with a very small medial mucosal incision adding two lateral punctiform incisions, thus enabling a four-point fixation of the Le Fort I fracture. This technique allows wide maxillary movements, significant maxillary expansion; and can be performed even if the surgeon does not have very specific instrumentation. Compared with previously described techniques, this approach offers equivalent surgical exposure, improved access for four-point fixation, and greater safety against mucosal tearing, while maintaining the minimally invasive concept.