Learning from the Past

January 1, 2013

New approaches to facial fracture surgery uncovered to address deformities

Innovations in Pediatrics - Winter 2013 - View Full PDF

Gregory E. Lakin, MD

Chief of Pediatric Plastic Surgery at UH Rainbow Babies & Children’s Hospital and Clinical Assistant Professor at Case Western Reserve University School of Medicine

A 30-year study on facial fracture surgery has uncovered previously unpublished techniques to fix deformities. 

Gregory E. Lakin, MD, Chief of the Division of Pediatric Plastic Surgery and Director of the Craniofacial Center at UH Rainbow Babies & Children’s Hospital and Clinical Assistant Professor of Plastic Surgery at Case Western Reserve University School of Medicine, led the review of patients who underwent the Le Fort II osteotomy. Le Fort II fractures are classic in facial trauma and involve the central nose and upper jaw. Surgery is required to repair the occlusion and restore function and balance to the face. 

The Le Fort fracture was named after French surgeon Rene Le Fort, who studied break patterns of injuries of cadavers and discovered the fracture patterns. In the 1960s, the Le Fort II osteotomy was introduced in craniofacial surgery and was electively performed on children with birth deformities to fix the nose and upper jaw to correct deformities.  

When the nasomaxillary deviation is to the left, the desired Le Fort II segment movement is to the right, and the osteotomies relative to the infraorbital foramen (IOF) are medial to the right IOF and lateral to the left IOF. Nasomaxillary deviations to the right require a left-sided Le Fort II segment movement, with osteotomies medial to the left IOF and lateral to the right IOF. Posteriorly displaced nasomaxillary deviations require a straightforward advancement with osteotomies made medial to the bilateral IOF

Dr. Lakin’s study was the first to report the use of bilateral upper eyelid incisions to approach the nasion and medical orbital walls for a Le Fort II osteotomy. Dr. Lakin’s research found that, over time, surgical techniques transitioned from coronal, lower eyelid crease and maxillary vestibular incisions to more minimally invasive techniques. And while surgeons previously advanced the nose and upper jaw by moving it forward in select patients, Dr. Lakin found it was sometimes necessary to move the nose and upper jaw side-to-side, as a swinging pendulum type movement. The study also defined where to perform osteotomies to achieve easier balance and whether to cut on the inside or outside of the infraorbital foramen. 

The paper, which Dr. Lakin wrote with Henry Kawamoto Jr., DDS, MD, a UCLA craniofacial surgeon, was published in the December 2012 issue of the Journal of Craniofacial Surgery. Dr. Lakin also will present at the 12th International Congress on Cleft Lip/Palate and Related Craniofacial Anomalies in 2013. 

Contact Dr. Lakin at Peds.Innovations@UHhospitals.org.

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