Home › Cases › Case 02

Case 02 · Jaw Surgery

Two-Piece Le Fort I and BSSO: Upper Jaw Widened and Moved Forward

A double-jaw case in which the upper jaw was divided into two segments and widened, then brought forward and up. The lower jaw was positioned to the new upper jaw. Planning and fixation were done with patient-specific guides and plates.

Before & afterPlanning3D CT

Concern: Wanted to bite better
Procedure: Two-piece Le Fort I with expansion; BSSO
Focus: Transverse: maxillary widening
Diagnosis: Skeletal Class III, narrow upper jaw, crossbite, open bite
Age range: 30s

Front · smiling

Front view before surgery, smiling, with braces

BeforeWith braces, before surgery

AfterAfter surgery

Bite · front

Bite photo before surgery, front, with braces: front teeth not overlapping

BeforeWith braces, before surgery

Bite photo after surgery, front, braces removed

AfterAfter surgery

Each Before and After pair is shown at the same size. Individual results vary.

Widening the upper jaw

The maxilla was planned in two segments, divided near the midline of the palate. The segments were opened 9.7 mm at the back, widening the arch across the first molars from 46.2 to 51.1 mm.

Upper intermolar width

46.2 → 51.1mm

Widened 4.9 mm

Upper intercanine width

32.4 → 33.9mm

Widened 1.5 mm

Posterior segment opening

9.7mm

Between the two segments

Before

Planned

Maxilla · viewed from belowBefore → planned. Intercanine 32.4 → 33.9 mm; intermolar 46.2 → 51.1 mm

Segment movementsEach point: right/left, forward, up (mm)

Two-piece maxilla · frontalSegments after expansion

Diagnosis & concern

Concern

His main concern was his bite. In his words, he wanted “to finally bite better.” His front teeth did not overlap when he closed, and his profile was concave.

Diagnosis

Skeletal Class III: the lower jaw sat forward of the upper jaw, with the chin slightly to the left. The upper jaw was narrow (about 5 mm too narrow across the back teeth), with a crossbite on the left side. The bite was Class III with an anterior open bite.

Surgical plan

The movements were planned on a 3D model from the CT scan, upper jaw first, and transferred to surgery with a palatal splint, cutting guides and patient-specific titanium plates for each maxillary segment.

Before

Planned

3D · Before → plannedFrontal view

Segment	Planned movement	Amount (from plan)
Maxilla (upper incisor)	Forward / up	4.0 mm / 3.0 mm
Maxilla (molar width)	Widened, two segments	46.2 → 51.1 mm
Mandible (lower incisor)	Back / up	0.3 mm / 5.2 mm
Chin point (pogonion), moving with the lower jaw · no chin surgery	Forward / up	2.1 mm / 5.1 mm
SNA / SNB	Change	+3.5° / +0.9°

Values as listed in the 3D surgical plan. Planned values; the operative result may differ slightly.

Procedure

Upper jaw divided into two segments, widened, and moved forward and up (two-piece Le Fort I osteotomy)
Lower jaw repositioned to the new upper jaw (bilateral sagittal split osteotomy)
Fixation with patient-specific titanium plates; palatal splint to hold the width. The plates are visible on the post-operative CT

3D CT · Before & after

3D CT before surgery and after surgery, shown at the same angle and scale. The fixation plates on the upper and lower jaw are visible after surgery.

Front

BeforeBefore surgery

3D CT after surgery, front view, with fixation plates

AfterFixation plates visible

Right side

BeforeBefore surgery

3D CT after surgery, right side, with fixation plates

AfterFixation plates visible

Side X-ray view (from the CT)

BeforeBefore surgery

Side X-ray view from the CT after surgery, with fixation plates

AfterFixation plates visible

Each CT pair is shown at the same angle and size. Individual results vary.

Where

Treated at Maxillo-Facial Surgery Institute, Irvine. Our Surgeons

Plan images are cropped from the 3D surgical planning report; measurements are shown as planned. Individual results vary; this page is educational and not medical advice.