Lefort 1 and Lip Incompetence

[sleepypies]

Hello,

I am officially diagnosed with Long Face Syndrome, and I have been approved by my insurance for Lefort 1 surgery. One of my biggest functional issues is lip incompetence. I have never been able to keep my mouth closed while falling asleep/sleeping and consequently ... well lots of drool. If I go forward with this surgery I would hope that my ability to keep my mouth closed at night would be dramatically improved. However, I've also been told that Lefort 1 won't help with mouth breathing.

Does anyone have any input on this issue? Will I likely be disappointed or is there a decent chance my ability to close my mouth at night will improve? I feel like the mouth breathing is more so caused due to the lip incompetence as opposed to airway issues, but I can't be sure. I'm not a big snorer, and if I focus on keeping my mouth closed I feel pretty okay breathing through my nose.

[kavan]

There are too many 'IF this than that' possibilities to go through to explain them all. But based solely on the assumption (which you are conveying here) that your surgery will be ONLY a Lefort 1 and NOT a BSSO or sliding genioplasty to go along with it, an 'ONLY' Lefort 1 for long face syndrome would imply:

a: The excess length is coming from the ANTERIOR maxilla and the L1 would involve a wedge section removal from the anterior maxilla to shorten the part of it that has the excessive length.

b: After that wedge section is removed, they will ROTATE the your maxilla upwards in a COUNTER CLOCKWISE direction which is called 'impaction'. It will also be free for them to move it forwards too if they need to and all that would/could be called your 'Lefort 1'

c: Doing 'b' above would allow your lower jaw to rotate counter clockwise and also move forward. That is called 'auto rotation' where a BSSO is not needed.

d: Although chin LENGTH and/or chin RECESSION is often the culprit to functional issues with lip incompetence where the correction to the chin can involve a sliding genioplasty to reduce the length and also bring chin forward IF that is needed to address the lip incompetence, a Lefort ONLY situation would imply that BOTH your lower jaw and chin were ROTATED too much CLOCKWISE and NEITHER needed to be cut into and displaced and that BOTH would be in the correct position to relieve lip incompetence subsequent to the Lefort 1 that would kick up counter clockwise AUTO ROTATION and/or auto advancement of both.


The above describes the key possibility of WHY a Lefort 1 ONLY could work and assumes you have relayed the information correctly where your implication is that you are getting ONLY a Lefort 1. However, if you have not conveyed the information correctly and if your surgery actually involves MORE than just the Lefort 1, nothing more can be said other than what I said based on your description of what you were getting.

[sleepypies]

Thank you for the detailed reply kavan.

I had my pre-op appointment yesterday. There was no mention of any surgery other than the Le Fort 1. I have the approval letter from my insurance as well and nowhere is it mentioned that any additional surgery requests were submitted or denied.

My bite has been described by two max surgeons as "pretty good" and the surgeon I have selected reaffirmed yesterday that this surgery should definitely help with the lip incompetence, including at night. I did not ask him about the possibility of other surgeries. I respect that other people on this board seem to have a lot of knowledge regarding the many different surgical approaches to fixing complex jaw issues. I personally get overwhelmed by all the names and medical lingo so I've decided not to delve into it and turn into an anxious mess. I hope this is not a mistake. I see other people have had the Le Fort 1 only to be told later that double jaw surgery was the better option aesthetically. For many reasons (financial, recovery wise, infection risks) I am much more comfortable with the Le Fort 1 only option. I'm definitely not expecting a brand new face so hopefully my limited expectations will serve me well!

Thanks again for your help.