Le Fort I osteotomy to correct malocclusion after reconstruction of the maxilla with the free fibula flap

Abstract

Malocclusion and facial asymmetry may follow microsurgical jawbone reconstruction. We describe the use of a Le Fort I osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. A 49-year-old patient with an extremely atrophied maxilla underwent alveolar crest augmentation by free fibula transfer. Bone healing was uneventful, but gross asymmetry of the reconstructed maxilla was apparent 3 months after surgery, with canting of the alveolar bone on the right side and residual skeletal discrepancy in the sagittal plane. A Le Fort I osteotomy was planned to correct malocclusion 6 months after fibula transfer. The maxilla was moved downward and forward and impacted in the right molar region. There were no postoperative complications. Solid bone union was achieved between the mobilized maxilla and the buttresses 3 months after surgery. At that time, osteointegrated implants were inserted, and an implant-supported prosthesis was completed. Neither bone resorption nor implant failure was encountered after 12 months of masticatory loading. Surgical correction of malocclusion after maxillary bone augmentation with the fibula flap is possible. Le Fort I osteotomy represents a reasonable option after microvascular alveolar bone reconstruction of the maxilla, when additional movements are required to restore facial symmetry and occlusion.