Congenital Craniofacial Deformity Surgery

Midface Advancement (Le Fort III)

Correcting mid-face retrusion in some craniofacial syndromes to improve mid-face projection and balance, which may also help breathing or protect the eyes.

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Overview

In some craniofacial syndromes, such as Crouzon and Apert, the mid-face grows less than the rest of the face. The eyes may appear prominent, the airway may narrow, and the lower jaw sits ahead of the upper jaw.

Le Fort III surgery moves the entire mid-face forward as one unit — the upper jaw, cheekbones, lower orbits and nose — to improve facial balance, protect the eyes and enlarge the airway, depending on the case.

Who May Benefit

Patients with craniofacial syndromes and mid-face retrusion
Patients with prominent eyes and corneal exposure
Patients with obstructive sleep apnoea due to a narrow airway
Patients with severe mid-face retrusion and a forward lower jaw

Conditions Treated

Mid-face hypoplasia
Crouzon syndrome
Apert syndrome
Pfeiffer syndrome
Exorbitism from shallow orbits
Obstructive sleep apnoea related to the mid-face

Diagnosis

Assessment includes the face, eyes and bite, 3D CT imaging, sleep study and airway evaluation when needed, an ophthalmology review, and a review of any previous skull surgery.

Treatment Planning

Timing depends on functional priority. Surgery may be done in childhood to protect the eyes or airway, recognising that the mid-face may not keep pace with the rest of the face and further correction may be needed later. The method is also chosen: immediate advancement during surgery, or gradual advancement with a distraction device.

Virtual Planning

3D Planning

The amount and direction of mid-face advancement are planned on a 3D model, assessing the effect on the eyes, airway and bite, and positioning the distraction device when used.

Surgical Overview

Surgery is usually performed through an ear-to-ear scalp incision hidden in the hair, sometimes with incisions inside the mouth. The mid-face is separated from the skull base through cuts in the nasal, orbital and cheek bones, then advanced either immediately with bone grafts or gradually with an internal or external distraction device over weeks. It may be combined with a Le Fort I to fine-tune the bite. It is performed under general anaesthesia within a multidisciplinary team.

Recovery

Patients are usually monitored in intensive care first, then on the ward for several days. Facial and eyelid swelling is marked in the first week. With distraction, the device is activated daily for several weeks and then left in place to consolidate before removal, with regular follow-up.

Risks & Considerations

All surgery carries risk. Potential risks are discussed in detail during consultation, and may include:

Bleeding and need for blood transfusion
Infection
Cerebrospinal fluid leak — uncommon
Change in eye position or double vision
Tear duct obstruction
Partial relapse with growth
Distraction device problems
Need for further surgery

Frequently Asked Questions

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

Le Fort I moves the upper jaw alone at tooth level, while Le Fort III moves the whole mid-face, including the cheekbones, lower orbits and nose.

Can surgery help breathing?

Mid-face advancement can enlarge the airway and improve sleep apnoea in some patients, which is assessed before and after surgery.

What is the right age for surgery?

It depends on the condition: in childhood when the eyes or airway are at risk, or after growth for definitive correction.

The information on this website is for general educational purposes and does not replace a consultation. Suitability for any procedure, and its potential benefits and risks, can only be determined following an individual clinical assessment. Individual results vary.

Discuss your options with Dr. Bakri

A consultation is the first step toward an accurate diagnosis and an individual plan.

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