Le Fort III
The Le Fort III is a craniofacial operation that can produce major changes in facial appearance. Patients who undergo Le Fort III reconstruction are usually diagnosed with syndromic craniosynostosis. Many of these patients have:
- Eye sockets which are shallow and small in size, causing the eyes to bulge out of the face.
- Difficulty completely closing their eyes when sleeping.
- The nose, cheekbones and upper jaw are pushed backwards, narrowing the breathing passage inside the mouth.
- In severe cases, the breathing passage can be so narrow that a tracheostomy is needed.
- The backward displacement of the upper jaw causes an underbite where the teeth of the upper jaw fall behind the lower jaw.
The Le Fort III operation addresses all of these facial changes. The surgery entails the careful separation of the bones of the middle third of the face from the remaining skull. Although effective, the Le Fort III is a major operation which takes many hours to perform, may require blood transfusion and is associated with significant facial swelling after surgery.
Hear a mother’s story:
What is the difference between a Le Fort III Classic and a Le Fort III Distraction procedure?
A Le Fort III Distraction achieves the same result, but the bones of the face are moved slowly over several weeks. This is done by attaching a halo device to the patient’s head.
Once the middle third of the face bone is separated from the rest of the face, a halo device is attached to the outside of the head. The halo is secured to the head using special screws that are secured to the head. The framework is then attached to the face and a splint is attached to the mouth. Wires may also be attached to the sides of the nose. The framework of the halo can look dramatic but it is generally not painful to wear. Alternatively, the bone lengthening device can be attached to the facial bones using a two or more devices that are buried underneath the skin of the face.
Watch a detailed explanation of each Le Fort III variation from Pat Chibbaro, Nurse Practitioner from the myFace Center for Craniofacial Care at NYU Langone Health:
The Process of a Le Fort III Procedure
Once the patient is asleep, many monitoring devices will be placed to ensure safety throughout the operation. Blood transfusion is very common during this procedure.
An opening is made on the top of the scalp from one side of the ear to the other. This opening may take the form of a wavy line to help hide the scar within the hair. If you have a scar on your scalp from a previous craniofacial surgery, this scar may be used. Sometimes, openings around the eyelids and inside of the mouth are required. During the procedure, the middle third of the face bone will be carefully separated from the rest of the skull. The segment of bone that is separated includes the bottom half of the eye sockets, the nose, the cheekbones and the upper jaw in one piece. Your surgeon will take extra care to maintain safety, limit blood loss and protect the eyes.
Once the middle third of the face bone is separated from the rest of the face, segments of bone will be placed in the spaces between the separated bones. These segments of bone will be taken from the hip and these bone pieces will fill the space between the bones and prevent the separated facial bone from moving back to its original position. After these segments of hip bone, called grafts are put into place, metal plates and screws are used to secure the bones into position. Sometimes wires are used to secure the patient’s teeth together. This is sometimes done to help keep the facial bones in place. Sometimes the LeFort III surgery is combined with other surgery of the face such as a LeFort I. A small drainage tube is commonly placed under the scalp skin which exits by the ear and into a collection bulb.
Post-Op & Recovery
The Le Fort III surgery produces dramatic swelling around the face and eyes. Fluid may drain from the scalp incision, mouth or eyes. Most of this fluid will stop draining after a couple of days. The eyes will also swell shut over the course of one to two days. Due to the swelling, eating can be a challenge at first. If the teeth are wired together there will be greater difficulty when attempting to eat. Speaking will also require some adjustment due to the facial swelling. The swelling should peak after 2-3 days and will slowly resolve over several weeks. Bruising around the eyes can also develop, but this will resolve over the course of approximately 2 weeks.
Most of the discomfort experienced after the surgery will be from the hip rather than the face. This pain can be significant and there may be difficulty walking at first. Medicine will be prescribed to help with any discomfort. It may take several weeks for the pain in the hip to completely resolve.
Healing & Recovery
Cool compresses to the face and sleeping with the face raised above the heart will also help decrease the swelling. Lip moisturizer is recommended to prevent drying of the lips. It is very important to listen to the surgeon’s directions regarding the types of foods one can eat following the surgery and when it is safe to eat them. Eating appropriate foods will help with the healing, but eating hard foods too early can damage the surgery. As the weeks pass, the swelling of the face and eyes will gradually subside and the changes to the face can be better appreciated. The cheekbones will look bigger and the eyes will no longer bulge forward. The eyes will fall back into a more normal appearance. The teeth of the upper jaw will be in a better position and the nose will look longer.