In this video, Steven Buchman MD, demonstrates how to correct the effects of a congenital craniofacial syndrome on a young woman by performing a High Wing Le Fort I Osteotomy and accompanying genioplasty. Dr. Buchman describes the importance of preoperative planning for the procedure and utilization of a surgical model based on impressions of the patient’s teeth. The model is marked and then adjusted to demonstrate the desired operative outcome. Measurements can then be taken to determine the amount of movement that must be achieved on the patient during the actual procedure. Dr. Buchman illustrates on the patient the various key points of anatomy while dissecting the maxilla and its four buttresses before cutting and finally down-fracturing the maxilla so that the upper tooth-bearing segment can be moved freely within the mouth. Utilizing a splint that was designed from the surgical model, Dr. Buchman places the upper to the lower mandible into IMF (Intermaxillary fixation; the proper closed bite position), and then demonstrates how to position the maxilla and the zygoma and remove bony and cartilaginous interferences to allow the osteotomized maxillary segment to be secured to the stable facial bones.

Following the successful plating of the Le Fort, Dr. Buchman demonstrates a genioplasty on the patient who has a very thick, vertically long and retrusive chin and demonstrates how removing an interpositional segment of bone from her chin will improve her resulting profile and bring her facial bones into better position and symmetry following the Greek “Golden Rule” of ideal facial proportion. After marking the midline and then removing an interpositional segment of bone, he demonstrates plating the remaining bones of the chin back together.

In the third and final portion of this patient’s combined procedures, Dr. Buchman then demonstrates how to shape the bone excised from the chin so that it can be grafted to the patient’s mid face in order to improve the projection and symmetry of the malar eminence.