Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy

Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r = ?0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.     

Accuracy of maxillary repositioning surgery using CAD/CAM customized surgical guides and fixation plates

The advent of three-dimensional imaging and computer-aided surgical simulation (CASS) have brought about a paradigm shift in surgical planning. The aim of this study was to assess the accuracy of maxillary repositioning surgery using computer-aided design and manufacturing (CAD/CAM) customized titanium surgical guides and fixation plates. Thirty consecutive adult patients, 13 male and 17 female, with a mean age of 29.2 years and 25.5 years, respectively, requiring Le Fort I maxillary osteotomy, with or without simultaneous mandibular surgery, were evaluated retrospectively. All orthognathic surgeries were performed by one experienced surgeon. The pre-surgical and post-surgical volumetric imaging were superimposed to assess the linear and angular differences between the planned and actual positions of the maxilla following surgery. With the use of the CAD/CAM titanium surgical guides and fixation plates, all surgical movements were within 2 mm and 4° of the planned movements, which is considered clinically insignificant. The overall root mean square error between the planned and actual surgical movements was 0.38 mm in the transverse dimension, 0.64 mm in the anteroposterior dimension, and 0.55 mm in the vertical dimension. In regard to the centroid of the maxilla, the absolute angular difference of the maxillary centroid was 1.06° in pitch, 0.47° in roll, and 0.49° in yaw. Maxillary repositioning surgery can be performed with high accuracy using CAD/CAM titanium surgical guides and fixation plates.     

Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult,but yields comparably stable results to one-segment osteotomy

This retrospective cohort study evaluated the postoperative outcomes of preoperatively planned positional changes for Le Fort I osteotomy in 77 patients (average age 26.6 years). Movement relapse and planning accuracy were evaluated by lateral cephalometric analysis, with an average follow-up of 257 days. In one-segment osteotomy cases, 73% of the horizontal movements were positioned within 2 mm of the surgical plan. With posterior–inferior repositioning of the maxilla, results fell within 2 mm of the prescribed plan in 60% of cases. Maxillary advancement and superior repositioning proved more stable than inferior maxillary repositioning. Relapse did not differ between three-piece and one-piece osteotomies for any movements; however, in three-piece cases, only half of the positional changes on average stayed within 2 mm of the prescribed surgical plan. Relapse did not vary with bone grafting among the groups. To summarize, in most Le Fort I osteotomy cases, the surgical plan is achieved within 2 mm, with posterior extrusion of the maxilla showing the greatest deviation both in reaching the target and maintaining the result achieved. Although maxillary segmentation makes the surgical plan more difficult to achieve, the results are at least as stable as those of one-piece osteotomies.     

Post-operative stability of the maxilla treated with Le Fort I and horseshoe osteotomies in bimaxillary surgery

In this study, the post-operative change of the maxilla in six non-cleft patients who underwent combination (Le Fort I and horseshoe) osteotomy for superior repositioning of the maxilla was investigated. In all patients, the maxilla was first osteotomized and fixed with four Luhr plates. No iliac bone graft was applied to the maxilla. A bilateral sagittal split ramus osteotomy of the mandible (BSSRO) was then carried out and titanium screw fixation was performed. No maxillo-mandibular fixation (MMF) with stainless steel wire was used post-operatively in any patient. Lateral cephalograms were obtained pre-operatively, 5 days post-operatively, and 3, 6, and 12 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisor (U1), and point of maxillary tuberosity (PMT) were examined. The maxillae in the six subjects were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and horseshoe osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy is comparatively stable.     

Improvement in accuracy of maxillary repositioning of Le Fort I osteotomy with Orthopilot™ Navigation System: evaluation of 30 patients

Traditional model surgery with facebow transfer is not very accurate. We aimed to demonstrate that the Orthopilot™ Navigation System improves the accuracy of maxillary repositioning during Le Fort I osteotomy. Thirty patients underwent Le Fort I osteotomy alone or associated to sagittal split osteotomy. The maxilla positioning was done in two phases. First, the maxilla was positioned with the traditional occlusal splint, the position (“without Orthopilot™”) was recorded by the Orthopilot™. In the second phase, the Orthopilot™ was used to improve positioning; and the final position (“with Orthopilot™”) was recorded, after osteosynthesis. Positioning data were compared with planned data. Positioning data with and without the Orthopilot™ were also compared. Accuracy was classified in distinct classes with three major criteria (conformity, non-conformity, failure) according to the discrepancies. Conformity rate was significantly greater with the Orthopilot™ (2 without the Orthopilot™ compared with 8 with the Orthopilot™; p = 0.01). The failure rate was significantly lower with the Orthopilot™ (18 without Orthopilot™ compared with 7 with the Orthopilot™; p = 0.002). Dispersions of discrepancies were usually lower in all directions with the Orthopilot™. Navigation reduced the risk of discrepancy without cancelling it, especially when large movements are planned. The Orthopilot™ therefore improved the accuracy of traditional occlusal splint during Le Fort I osteotomy.     

Stability of the Le Fort I osteotomy with anterior internal fixation alone: a case series.

PURPOSE: The purpose of this case series was to evaluate the late postsurgical stability of the Le Fort I osteotomy with anterior internal fixation alone and no posterior zygomaticomaxillary buttress internal fixation. PATIENTS AND METHODS: Sixty patients with maxillary vertical hyperplasia and mandibular retrognathia underwent a 1-piece Le Fort I osteotomy of the maxilla with superior repositioning and advancement or setback. A bilateral sagittal split ramus osteotomy for mandibular advancement was also performed in 22 patients. Stabilization of each maxillary osteotomy was achieved using transosseous stainless steel wires and/or 3-hole titanium miniplates in the piriform aperture region bilaterally, with no zygomaticomaxillary buttress internal fixation. (Twelve of the 60 identified patients were available for a late postoperative radiographic evaluation.) Lateral cephalometric radiographs were taken preoperatively (T1), early postoperatively (T2), and late postoperatively (T3) to analyze skeletal movement. RESULTS: These 12 patients (5 male, 7 female) had a mean age of 24.5 years at surgery. Mean time from surgery to T2 was 41.2 days; mean time from surgery to T3 was 14.8 months. One patient received anterior wire osteosynthesis fixation, while 11 patients received both anterior titanium miniplate internal skeletal fixation and anterior wire osteosynthesis fixation. Six patients underwent Le Fort I osteotomy with genioplasty, 1 patient underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy, and 5 patients underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy and genioplasty. These 12 patients all underwent maxillary superior repositioning with either advancement (11 patients) or setback (1 patient). Statistically significant surgical (T2-T1) changes were found in all variables measured. In late postsurgical measurements (T3-T2), all landmarks in the horizontal and vertical plane showed statistically significant skeletal stability. CONCLUSION: This case series suggests that anterior internal fixation alone in cases of 1-piece Le Fort I maxillary superior repositioning with advancement has good late postoperative skeletal stability.     

Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion

The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2 mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28 ± 2.63 mm and mean lengthening was 0.92 ± 1.76 mm. Eight subjects (8.70%) had relapse (>2 mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P = 0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.     

Changes in border movement of the mandible in skeletal Class III before and after orthognathic surgery

The purpose of this study was to examine the changes in border movement of the mandible before and after mandibular ramus osteotomy in patients with prognathism. The subjects were 73 patients with mandibular prognathism who underwent sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy. Border movement of the mandible was recorded with a mandibular movement measure system (K7) preoperatively and at 6 months postoperatively. Of the 73 patients, 21 had measurements taken at 1.5 years postoperative. Data were compared between the pre- and postoperative states, and the differences analyzed statistically. There was no significant difference between SSRO alone and SSRO with Le Fort I osteotomy in the time-course change. The values at 6 months postoperative were significantly lower than the preoperative values for maximum vertical opening (P = 0.0066), maximum antero-posterior movement from the centric occlusion (P = 0.0425), and centric occlusion to maximum opening (P = 0.0300). However, there were no significant differences between the preoperative and 1.5 years postoperative measurements. This study suggests that a postoperative temporary reduction in the border movement of the mandible could recover by 1.5 years postoperative, and the additional procedure of a Le Fort I osteotomy does not affect the recovery of mandibular motion after SSRO.     

Comparison of biomechanical behaviour of maxilla following Le Fort I osteotomy with 2- versus 4-plate fixation using 3D-FEA: Part 3: Inferior and anterior repositioning surgery

Having studied the effect of maxillary advancement and maxillary impaction in parts 1 and 2 of this research, the purpose of this study was to investigate the biomechanical behavior of different fixation models in inferiorly and anteriorly repositioned maxilla following Le Fort I osteotomy. Two separate three-dimensional finite element models, simulating the inferiorly advanced maxilla at Le Fort I level, were used to compare 2- and 4-plate fixation. Model INF-2 resulted in 247 897 elements and 53 247 nodes and INF-4 consisted of 273 130 elements and 59 917 nodes. The stresses occurring in and around the bone and plate–screw complex were computed. The highest Von Mises stresses on the plates and maximum principal stresses on the bones were found in INF-2, especially under horizontal and oblique loads, when compared with INF-4. The present biomechanical study shows that the traditionally used 4-plate fixation technique, following Le Fort I inferior and anterior repositioning surgery, without bone grafting, provides fewer stress fields on the maxillary bones and fixation materials.     

Comparison of maxillary setback by maxillary tuberosity removal or intentional pterygoid plate fracture in Le Fort I osteotomy: a long-term evaluation

The purpose of the study was to investigate the clinical application and long-term stability of maxillary setback in Le Fort I osteotomy using maxillary tuberosity removal or intentional pterygoid plate fracture (IPPF). Eighty adult class II patients who underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy by the same surgeon between January 2013 and January 2019 were included in this retrospective study. Traditional maxillary tuberosity removal was performed in 40 patients (group I), and the other 40 patients (group II) underwent IPPF to set back the maxilla according to surgeon preference. An obvious change in profile was observed for all of the patients, with no significant relapse at 1 year postoperative. The operation time and intraoperative blood loss were significantly higher in group I than in group II (P =  0.037 and P =  0.021, respectively). In group II, the most superior point of the fracture line was at a mean distance of 12.25 ± 2.04 mm above the most inferior point of the pterygoid plate. More bone fragments were noted when the fracture level was low than when it was high. In conclusion, both maxillary tuberosity removal and IPPF resulted in sufficient and stable maxillary setback, with IPPF showing less blood loss and a shorter operative time.     

Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements

This retrospective study was performed to verify the accuracy of horizontal and vertical repositioning of the maxilla in bimaxillary osteotomy with a focus on posterior vertical displacement. Data from 39 orthognathic patients undergoing bimaxillary surgery including a one-piece Le Fort I osteotomy with pitch rotation and advancement at the University Hospitals of Leuven (Belgium), between January 2015 and April 2016, were included in the study. Preoperative and 1-week postoperative lateral cephalograms were digitized and imported into cephalometric software. Horizontal and vertical measurements of dental landmarks were used to assess the accuracy of maxillary repositioning, and errors were reported in terms of the mean and absolute mean. The horizontal advancements were randomly under- and over-corrected an average of 1.4 mm ± 1.2 mm. Vertical repositioning of the anterior maxilla followed the planning. A tendency for under-correction was found for posterior vertical intrusion of the maxilla. The same tendency towards under-correction of posterior maxillary inferior repositioning was detected when planned movements were greater than 3 mm. For all studied groups, no significant difference was found between the planning and the results achieved, validating the use of intermediate splints.     

Effect of setback Le Fort I osteotomy on midfacial soft-tissue changes as evaluated by cone-beam computed tomography superimposition for cases of skeletal Class III malocclusion

This study employed the cone-beam computed tomography (CBCT) superimposition method to evaluate postoperative midfacial soft-tissue changes in cases of skeletal Class III malocclusion after double-jaw surgery with setback and vertical reduction Le Fort I osteotomy. A retrospective study was carried out on 15 patients who had undergone maxillary setback Le Fort I osteotomy and mandibular setback sagittal split ramus osteotomy with alar cinch suturing and V-Y soft-tissue closure. Three dimensional CBCT volume scans were recorded preoperatively (T0) and 6 months postoperatively (T1) to measure soft-tissue changes of the upper lip and midface. Post-surgery, soft-tissue landmarks in the cheek and paranasal areas had moved forward; the soft-tissue thickness at the A-point had markedly increased (P < 0.05); there was no significant change in the subnasale, and the midline of the soft-tissue of the upper-lip area had moved backward. The extent of the mean soft-tissue change at the labrale superius was greater than that at the other soft-tissue landmarks of the upper lip. The results suggest that maxillary setback movement of the maxilla by alar cinch suturing has a beneficial effect on paranasal soft-tissue and lip contours for patients with protrusive lip and acute nasolabial angle.     

Effects of maxillary advancement and impaction on nasal airway function

The effects of Le Fort I osteotomy on the nasal airway are controversial. This study aimed to evaluate nasal airway changes after Le Fort I. 25 patients underwent conventional Le Fort I osteotomy and were separated into three groups depending on the type of surgery they underwent. 11 patients needed maxillary impaction, 9 underwent maxillary advancement, and 5 had both maxillary impaction and advancement. Rhinological examinations, anterior rhinomanometry and acoustic rhinometry were carried out 1 week before surgery and 3 months after that. Wilcoxon and χ² tests were used for data analysis. The samples included 19 females and 6 males with a mean age of 22.4 ± 3.32 years. Rhinomanometric assessment showed that total nasal airflow was increased from 406 ± 202 ml/s to 543 ± 268 ml/s in all three groups. Significant decrease in nasal airway resistance was seen in all three groups. Acoustic rhinometry revealed a significant decrease in total nasal volume but an increase in the cross-sectional areas of isthmus nasi (IN) and inferior concha. The rhinomanometric measurements showed improvements in the total nasal airflow after Le Fort I osteotomy with alar base cinch suture in cases where the impaction was not higher than 5.5 mm.     

Transverse maxillary stability assisted by a transpalatal device: A retrospective pilot study of 9 cases

This retrospective pilot study assessed the transverse stability of an original surgical approach in nine patients with moderate transverse maxillary deficiency associated with a sagittal and/or vertical skeletal anomaly. During the one-stage surgical procedure, bi- or three-dimensional anomalies were corrected. Maxillary expansion was guided by a transpalatal bone-anchored device (TPD?). Expansion measurements were made 1-2 months before surgery, 6 and at least 12 months after surgery. The transverse occlusion was corrected in all cases. After 12 months the gingival landmarks revealed an expansion range from ?0.83 to +2.92 mm for the cuspids, +1.66 to +6.23 mm for the bicuspids and from +2.68 to +4.80 mm for the molars. For the occlusal landmarks, expansion ranged from -2.01 to +3.15 mm (cuspids), from +1.11 to +7.13 mm (bicuspids) and from +2.70 to +6.26 mm (molars). Cuspid expansion was significantly smaller than that of bicuspids and molars. This more posterior expansion was achieved through the surgical procedure. The transverse stability obtained with the aid of the bone-anchored TPD? was satisfying. This preliminary study supports the principle of an original surgical approach, called ‘Le Fort I – TPD’, which combines a Le Fort I osteotomy with a controlled maxillary expansion.     

Outcome of surgical-orthodontic treatment in hemifacial microsomia with and without early mandibular distraction osteogenesis

The aim of this study was to compare the outcomes of surgical-orthodontic treatment between hemifacial microsomia (HFM) patients who had and had not undergone early mandibular distraction osteogenesis (DO). Twenty adult unilateral HFM patients were included, seven who had undergone early mandibular DO (DO group) and 13 who had not (NDO group). All patients were type IIB, except for one type IIA patient in the NDO group. Mean age at definitive surgery was 20.72 ± 2.96 years. Linear, cross-sectional, and volumetric measurements were obtained from serial cone beam computed tomography scans. Data were obtained pre-surgery (T0), 1 week after surgery (T1), and at treatment completion (T2) to determine surgical movement, post-surgical stability, and net gain movement. Surgical and ultimate outcomes did not differ significantly between the groups. The overall surgical movement among all patients was as follows (mean values): maxillomandibular complex (MMC) symmetry was achieved by Le Fort I differential roll movement (3.78 mm extrusion on the affected side, 4.28 mm impaction on the non-affected side), a combination of medial movement and yaw rotation of MMC, and genioplasty. Upper and lower dental midlines and deviated menton were shifted by 5.73 mm, 5.08 mm, and 12.38 mm, respectively. Anterior impaction and advancement with counterclockwise rotation of MMC were also performed. Menton was advanced by 6.14 mm and lower facial height was increased by 3.55 mm. Neither group exhibited a significant difference in stability. Relapse at the maxilla was <1 mm and relapse at the mandible was <1.5 mm. The results suggest that early DO had limited beneficial effects on the definitive correction outcome. HFM patients achieved acceptable symmetry and a stable surgical outcome, regardless of early DO, following surgical-orthodontic correction at skeletal maturity with three-dimensional surgical simulation.     

Two-point nasomaxillary fixation of the Le Fort I osteotomy: assessment of stability at one year postoperative

The purpose was to assess maxillary position among patients undergoing Le Fort I maxillary advancement with internal fixation placed only at the nasomaxillary buttresses. This was a retrospective study of patients undergoing a Le Fort I osteotomy for maxillary advancement, with internal fixation placed only at the nasomaxillary buttresses. Demographic and cephalometric measures were recorded. The outcome of interest was the change in maxillary position between immediately postoperative (T1), 6 weeks postoperative (T2), and 1 year postoperative (T3). Fifty-eight patients were included as study subjects (32 male, 26 female; mean age 18.4 ± 1.8 years). Twenty-five subjects (43.1%) had a diagnosis of cleft lip and palate. Forty-three subjects (74.1%) had bimaxillary surgery, 16 (27.6%) had bone grafts, and 18 (31.0%) had segmental maxillary osteotomies. At T3, there were no subjects with non-union, malunion, malocclusion, or relapse requiring repeat surgery. Mean linear changes between T1 and T3 were ≤1 mm. Mean angular changes between T1 and T3 were <1°. There was no significant difference in stability in multi-segment maxillary osteotomies (P =  0.22) or with bone grafting (P =  0.31). In conclusion, anterior fixation alone in the Le Fort I osteotomy results in a stable maxillary position at 1 year postoperative.     

Postoperative stability following maxillary downward movement with Le Fort I inclined osteotomy at the lateral nasal cavity wall

Downward movement of the maxilla is regarded as one of the less stable long-term orthognathic surgical procedures. To increase postoperative stability with direct bone contact, the conventional Le Fort I osteotomy was modified with an inclined osteotomy at the lateral nasal cavity wall. The aim of this study was to evaluate the postoperative stability of the new method for Le Fort I inclined osteotomy for downward maxillary movement.The study included 27 patients with anterior vertical deficiency of the maxilla who underwent Le Fort I inclined osteotomy for downward maxillary movement. Patients were classified into two groups according to the amount of downward movement. The amounts of relapse (cephalometric changes) of the two groups were compared and statistically analyzed.The mean amount of relapse was about 1 mm. The tendency of relapse was not increased by a large initial downward movement with Le Fort I inclined osteotomy. Le Fort I inclined osteotomy was used safely for downward movement in order to increase bone height at the piriform aperture area and resulted in direct bone contact, suggesting it is a useful technique for maintaining postoperative stability. A further study with a larger number of patients is necessary.     

Accuracy of mandible-independent maxillary repositioning using pre-bent locking plates: a pilot study

The double splint method is considered the gold standard for maxillary repositioning, but the procedure is lengthy and prone to error. Recent splintless methods have shown high repositioning accuracy; however, high costs and technical demands make them inaccessible to many patients. Therefore, a new cost-effective method of mandible-independent maxillary repositioning using pre-bent locking plates is proposed. Plates are bent on maxillary models in the planned position prior to surgery. The locations of the plate holes are replicated during surgery using osteotomy guides made from thermoplastic resin sheets. Pre-bent plates are subsequently fitted onto the maxilla, and plate holes are properly set to reposition the maxilla. The purpose of this study was to evaluate the accuracy of this method for maxillary repositioning and the reproducibility of the plate holes. Fifteen orthognathic surgery patients were evaluated retrospectively by superimposing preoperative simulations over their postoperative computed tomography models. The median deviations in maxillary repositioning and plate hole positioning between the preoperative plan and postoperative results were 0.43 mm (range 0–1.55 mm) and 0.33 mm (range 0–1.86 mm), respectively. There was no significant correlation between these deviations, suggesting that the method presented here allows highly accurate and reliable mandible-independent maxillary repositioning.     

Precise control of maxillary multidirectional movement in Le Fort I osteotomy using a surgical guiding device

We introduced a surgical protocol to achieve accurate maxillary multidirectional movement in Le Fort I osteotomies. This comprised a way of controlling precision and a guiding device together with prebent titanium plates. We evaluated the protocol using a semiautomated 3-dimensional assessment in 22 patients with maxillary multidirectional movement (movement in three or more of six directions). Operations were all done between October 2015 and April 2017 by the same surgeon, who followed the protocol strictly. To evaluate the accuracy, we measured the deviation of the orientation of landmarks and of the upper dentition. All cases were followed up for at least a year. They all involved maxillary movement in at least three directions, and nine involved movement in six. The guiding device was used intraoperatively in all cases. Vertical deviation of the segments of bone was often detected during removal of bone, and sagittal deviation in three cases, but we found no transverse deviations. The assessment of accuracy showed that the mediolateral, anteroposterior, and superoinferior translations of landmarks were all less than 1 mm, with mean values of 0.29, 0.43, and 0.39 mm, respectively. The pitch, roll, and yaw of the upper dentition were also less than 1°, with mean values of 0.60°, 0.35°, 0.36°, respectively. The proposed protocol allowed accurate reposition of the maxilla with multidirectional movement during Le Fort I osteotomy.     

Maxillary sinus recovery and nasal ventilation after Le Fort I osteotomy: a prospective clinical,endoscopic, functional and radiographic evaluation

The condition of the maxillary sinus is not routinely assessed before a Le Fort I osteotomy. Performing this procedure in an infected sinus might account for a considerable proportion of the complications, such as excessive bleeding and sinusitis. The aim of this study was to evaluate the maxillary sinus and nasal ventilation after Le Fort I osteotomy. Twenty patients were evaluated before and 2 months after surgery using validated questionnaires for sinonasal complaints (RSOM-31 and VAS score), nasal endoscopy, peak nasal inspiratory flow (PNIF), and a computed tomography (CT) scan. There were no differences in complaints before and 2 months after surgery (P > 0.24). Also, the PNIF did not change significantly (P = 0.10). On CT evaluation before surgery, a previously unnoted sinusitis was diagnosed in two patients. Postoperatively, a thickened sinus mucosa was present in all patients near the osteotomy line, the osteosyntheses, and around sequesters. This report describes maxillary sinus evaluation after Le Fort I osteotomy in a more comprehensive way by using CT. The Le Fort I procedure did not influence already existing physical or mental complaints, and nasal ventilation was not negatively affected. However, evaluation of sinonasal pathology should be emphasized in the preoperative work-up.