What is a Le Fort 1 osteotomy?

A Le Fort 1 osteotomy is an operation to change the position of your upper jaw so your teeth can be aligned.

What are the benefits of surgery?

Your orthodontist should be able to align your teeth so they bite together in the best way for long-term stability. The appearance of your face should also improve.

Are there any alternatives to surgery?

Your orthodontist can sometimes just use braces to straighten your teeth but it is unlikely that your teeth will bite together properly. You will usually need a permanent wire across the back of your teeth or to wear a splint at night for the rest of your life to keep your teeth in place.

What will happen if I decide not to have the operation?

It is unlikely your teeth will be aligned properly and the alignment of your teeth may get worse over time.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes about an hour.

Your surgeon will make cuts inside your mouth, above your top teeth.

They will use instruments to separate the part of your upper jaw which holds your teeth while maintaining the blood supply. Your surgeon will move your jaw and fix it in the right position using plates and screws. Your surgeon may need to trim the cartilage that separates your nostrils to prevent your nose from becoming permanently blocked.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Stopping smoking and keeping your mouth clean significantly reduces the risk of infection.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious.

General complications of any operation

• Bleeding during or after the operation. If the bleeding is heavy, you may need a blood transfusion. You may also cough up some blood for 2 weeks.
• Bruising and swelling of your jaw, mouth and nose. Any swelling or bruising usually settles within 2 to 3 weeks. Sometimes the base of your nose can stay swollen for a few months.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Blood clot in your leg (deep-vein thrombosis - DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Numbness of the upper lip and gum. This usually recovers within a few weeks but may be permanent.
• The jaw not separating as planned. Your surgeon may need to wire your jaws together for up to 12 weeks. You will be able to eat only liquidised food.
• Not being able to open your mouth fully (trismus) and jaw stiffness. Rarely, this can be permanent.
• Slipping of the jaw bones in the first few weeks after the operation.
• Cosmetic problems. Any changes usually settle within 3 to 6 months.
• Infection of the plates and screws after a number of months. You will need another operation to remove them if the infection keeps coming back.

Consequences of this procedure

• Pain.

How soon will I recover?

You should be able to go home after 1 to 3 days.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Eat only soft foods for 4 to 6 weeks, gradually moving on to solid food only when you can chew comfortably. It will take about 3 months before you can chew properly.

You should be able to return to work after 2 to 4 weeks, depending on your type of work.

The healthcare team will arrange for you to come back to the clinic regularly during the first 4 weeks.

Summary

A Le Fort 1 osteotomy is an operation to change the position of your upper jaw to help improve the way your teeth bite together. It is usually performed in addition to treatment by your orthodontist using braces.

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