Simultaneous Le Fort I osteotomy with alloplastic implant augmentation: a novel strategy for midface deficiency

This retrospective study evaluates a novel approach for the correction of high-level maxillary hypoplasia. Deficiency of the midface at the nasolabial area (low-level deficiency) can be effectively corrected using conventional Le Fort I osteotomy. However, midface deficiency at the level of the zygoma, infraorbital region, and lateral nasal region (high-level deficiency) cannot be adequately addressed through standard Le Fort I advancement alone. Management options for high-level deficiency include high-level Le Fort I osteotomy, alloplastic implants, or injectable fillers. In this study, 35 patients requiring orthognathic surgery (either bimaxillary surgery or isolated maxillary osteotomy) underwent simultaneous placement of alloplastic implants, including silicone and polyetheretherketone (PEEK) implants. A minimally invasive technique was used to perform the Le Fort I osteotomy. Through the same intraoral incision, the incision was extended, and a subperiosteal pocket was dissected in the zygomatic region to allow proper placement of the implant, following principles described in previously published techniques (e.g., Niamtu et al.). The size and shape of the implant were determined based on preoperative clinical evaluation and confirmed intraoperatively. Each implant was secured in the desired position using two titanium screws. Postoperative follow-up revealed satisfactory outcomes in the majority of cases. Only one case of infection was reported, which occurred in a silicone implant. All patients demonstrated noticeable improvement in lateral and oblique facial profiles and expressed satisfaction with the aesthetic outcomes during follow-up visits. The findings of this study demonstrate the feasibility of performing Le Fort I osteotomy in conjunction with simultaneous alloplastic implant placement during a single operative session. This combined approach reduces the psychological burden associated with undergoing two separate procedures and provides a more cost-effective treatment option while achieving enhanced midfacial contour and aesthetic improvement.