What is a Le Fort osteotomy?

Le Fort osteotomy is a type of corrective jaw surgery in which the upper jaw — and in some cases, portions of the mid-face — are surgically separated and repositioned. It is intended to improve facial structure, bite function and appearance. 

Le Fort osteotomy is often recommended for patients with cleft lip and palate who have an underdeveloped upper jaw (maxillary hypoplasia). It is also intended for children with craniofacial syndromes that affect how the face grows.

Though spelling may differ, LeFort and Le Fort refer to the same procedure, named after French surgeon René Le Fort. 

Children's Hospital of Philadelphia's Cleft Lip and Palate Program, part of our larger Craniofacial Program, performs Le Fort osteotomies regularly. They are a key element of an integrated, long-term surgical care plan, often for patients who have been with CHOP since infancy.

What are the three types of Le Fort osteotomy?

The type of Le Fort osteotomy your child may need will differ based on specific patient treatment plans. There are many different craniofacial conditions for which a Le Fort osteotomy may be recommended.

Due to their complexity, Le Fort II and III require additional expertise in craniofacial reconstruction. Both Le Fort II and III are performed through an intraoral incision and an ear-to-ear (coronal) incision. They are commonly combined with a technique called distraction osteogenesis in which a halo or internal device is attached to the cut segments and activated daily. The bones are then gradually moved forward until the desired position is reached.

Le Fort osteotomy II and III are commonly completed at an earlier age and may need to be repeated later in life.

The three types of Le Fort osteotomy are:

• Le Fort I is the most common type. The upper jaw is separated from the rest of the facial skeleton at a horizontal level above the teeth. The jaw can be moved forward, backward, up or down. Surgery is performed entirely inside the mouth, leaving no visible facial scar.
• Le Fort II is a more extensive procedure that includes the nose and central portion of the face. Used for patients with more complex issues affecting the orbital floor and nasal bones.
• Le Fort III is the most extensive procedure. It involves moving the entire mid-face forward, including the cheekbones and orbital rims. 

CHOP's expert craniofacial team has successfully treated patients with all three types of Le Fort osteotomy.

Your care team will recommend the level of surgery that best addresses your child's specific anatomy and condition.

When is a Le Fort osteotomy recommended?

There are a number of conditions, syndromes and other indicators which may suggest the need for a Le Fort osteotomy. These include:

• Cleft lip and palate with maxillary hypoplasia
  • For some children with cleft lip and palate, the upper jaw does not develop normally as they grow. This is one of the most common reasons a Le Fort I osteotomy is recommended. 
  • CHOP also offers cleft lip surgical repair, including for older kids and teens.
• Craniofacial syndromes
  • Apert syndrome
  • Crouzon syndrome
  • Pfeiffer syndrome
  • Treacher Collins syndrome
  • Other syndromes that affect mid-face growth
• Significant bite misalignment (malocclusion)
  • Upper and lower teeth don't meet properly due to skeletal differences which are not correctable by orthodontics.
• Facial asymmetry
  • Upper jaw or mid-face grows unevenly, affecting both appearance and function. 
• Obstructive sleep apnea in select cases
  • Children with certain craniofacial anatomies may benefit from airway adjustment. 

Most Le Fort osteotomies are performed at skeletal maturity, which is typically between ages 14 and 18 for girls and ages 16 and 18 for boys. Earlier intervention may be considered for younger children with severe hypoplasia.

What to expect: Before, during and after a Le Fort osteotomy

Le Fort osteotomy is a complex procedure, and as a parent considering this surgery for your child, you may be curious about what to expect. 

Below, you'll find out more about what happens before, during and after Le Fort osteotomy, so that you and your family can be prepared for every stage of your child's treatment journey.

Before surgery

• Pre-surgical orthodontics
  • Most patients require 12 to 18 months of orthodontic preparation before surgery. This time is used to align the teeth for surgical repositioning.
• Pre-surgical imaging
  • 3D CT, cephalometric X-rays 
  • CHOP uses virtual surgical planning to plan the exact movements before the operation. 
• Pre-surgical appointment
  • This will include all final pre-surgical planning, including the parent and child meeting the full team. Pre-surgical images will be discussed, as well as the overall procedure plan.
    • An anesthesia plan will also be discussed, including any allergies

During surgery 

The surgery is performed under general anesthesia. A cut is made inside the mouth. This means there is no external facial incision and no visible scar. The upper jaw is carefully separated and repositioned. 

Titanium plates and screws are then placed to hold the jaw in its new position.

Typically, a Le Fort osteotomy Type I procedure will take between two and three hours. As they are more complex, Le Fort osteotomy II and III tend to take longer. 

Your provider will discuss specific surgical expectations based on the type of Le Fort osteotomy your child is undergoing.

After surgery

• Hospital stay
  • Typically, a child undergoing Le Fort osteotomy Type I will only need to stay in the hospital for a single night. The timeline is often longer for children undergoing Le Fort osteotomy Type II and III.
  • Swelling and numbness are expected. Elastic bands may be used temporarily to guide bite alignment. 
• Recovery milestones
  • Week 1 to 2: Liquid diet, significant swelling, limited activity
  • Week 3 to 6: Soft foods introduced, swelling decreasing
  • Week 6 to 8: Most patients return to school and other normal activities
  • 3 to 6 months: Orthodontic adjustment resumes
  • 6 to 12 months: Full healing
  • This is a general timeline; your care team will provide guidance specific to your child
• Speech monitoring for cleft patients
  • Children undergoing Le Fort osteotomy Type I as part of cleft care should have their speech assessed before and after surgery. Maxillary advancement can affect velopharyngeal function and CHOP's integrated team of surgeons and speech-language pathologists monitors this proactively. 

Le Fort osteotomy risks and considerations

There are, of course, common risks associated with Le Fort osteotomy, as with any complex medical procedure. It's important to be aware of each of the possible outcomes below, so that you and your family can be prepared to deal with any complications that may arise.

Common Le Fort osteotomy risks include:

• Swelling and temporary numbness 
• Temporary bite adjustment with elastic bands
• Infection risk
• Bleeding

Some swelling and numbness are normal and expected, and the infection risk is generally low. No matter the type of Le Fort osteotomy, your child will require follow-up orthodontic care. 

Le Fort osteotomy Type I advancement in cleft palate patients carries a risk of velopharyngeal insufficiency (VPI). This means the soft palate may not compensate for the increased distance after jaw advancement, affecting speech. CHOP's team assesses VPI risk before surgery and monitors speech after.

In rare cases, your child's jaw may shift slightly after surgery. CHOP's virtual surgical planning and precise fixation techniques minimize this risk as well.

Our team will walk you through the specific risks relevant to your child's anatomy and surgical plan during your consultation. 

No two patients are the same. At CHOP, we tailor our approach to each child.

Why choose CHOP for a Le Fort osteotomy

Many patients who need a Le Fort osteotomy have been CHOP patients since birth. We offer integrated care from infancy through adulthood, and in those cases, our team already knows your child's anatomy, surgical history and care plan. 

We are always ready and willing to welcome new patients. CHOP is consistently ranked among the nation's best children's hospitals. Our Craniofacial Program is one of the largest single centers of its kind in the world. CHOP's Division of Plastic, Reconstructive and Oral Surgery performs more than 1,200 surgical procedures per year. Our surgeons also consult internationally, helping to train the next generation of craniofacial surgeons.

CHOP uses advanced 3D digital simulation to plan the exact positioning of your child's jaw before surgery. This increases precision and allows the surgical team to anticipate and solve problems before your child is in the operating room. For cleft patients, we offer speech assessment before and after surgery to monitor velopharyngeal function.

Together, a team of world-class plastic surgeons, orthodontists, speech-language pathologists, audiologists and psychosocial support specialists will coordinate your child's care at CHOP. 

Frequently asked questions about Le Fort osteotomy

If your child has been recommended for Le Fort osteotomy, you likely have questions. Below, we answer some of the most common and frequently asked questions regarding Le Fort osteotomy and what families can expect.

What is the difference between Le Fort I, II and III? 

Le Fort osteotomy Type I only moves the upper jaw. Le Fort osteotomy Type II moves the upper jaw plus nasal bones. Le Fort osteotomy Type III moves the entire mid-face including cheekbones and orbits. Ask your provider for more specific details regarding the differences between Type I, II and III.

How long does Le Fort osteotomy surgery take? 

Le Fort osteotomy Type I procedure takes between two and three hours. As they are more complex, Le Fort osteotomy II and III take longer. Your care team will give you a specific timing estimate based on your child's plan. 

How long is the recovery from Le Fort osteotomy? 

Recovery time varies by procedure type and child. For Le Fort osteotomy Type I, most children return to school within six to eight weeks. Full healing often takes somewhere between six and 12 months. A liquid and soft food diet is required for the first several weeks.

Will my child have a visible scar from Le Fort surgery? 

Le Fort I osteotomy is performed entirely inside the mouth through an incision in the gum tissue. There is no external facial incision and no visible scar on the face.

At what age is Le Fort osteotomy performed? 

Procedure timing is based mostly on growth assessments, though Le Fort osteotomies are often performed at or near skeletal maturity. For children with severe mid-face deficiency who cannot wait, distraction osteogenesis may be an option. 

Does my child with cleft palate need a Le Fort osteotomy? 

Not all children with cleft palate need a Le Fort osteotomy. It is recommended when the upper jaw has not developed sufficiently, a condition which occurs in a subset of cleft palate patients. At CHOP, our team monitors your child's growth over time and recommends surgery only when indicated. 

Can Le Fort osteotomy affect my child's speech? 

For children with cleft palates, Le Fort osteotomy Type I jaw advancement can affect the soft palate's ability to close properly during speech. In some cases, speech therapy or additional procedures may be recommended.

Request an appointment with CHOP's craniofacial team

If your child has been part of CHOP's Cleft Lip and Palate Program, our team is already familiar with their history and surgical plan. If your child hasn't yet visited CHOP or joined the Craniofacial Program, our expert team is always ready to welcome new patients and their families.

We accept referrals from pediatricians and specialists nationwide.

Request an Appointment 215-590-2208