Modified Lefort 3 Cut by Sinn

[PloskoPlus]

OH, OK. Thanks. So, the author must have been the Australian surgeon  that Sinn told someone on here he does the mod L3 in that fashion. I just knew Hegge wrote a paper called 'Modified l3' and he's Australian. But I didn't get it because I didn't want to register just to read it.

I have the paper if you want it. The result is not impressive. They look quite asymmetric. The infraorbital and occlusal levels can have very different asymmetries. So one in constrained by the other. And if the occlusion is good, this kind of surgery cannot be done.

[kavan]

I have the paper if you want it. The result is not impressive. They look quite asymmetric. The infraorbital and occlusal levels can have very different asymmetries. So one in constrained by the other. And if the occlusion is good, this kind of surgery cannot be done.

But the mod L3 doesn't move the teeth.

[micjawsurgery]

Kavan, I asked about how the cut is made. From Sinn: the eye is lifted up from the floor to access the inferior orbital fissure to make the bone cut from the superior orbital fissure down to inferior fissure.

I also asked about doing the operation intraorally to hide the scar - I saw some pics of Earl that showed his scarring, which was quite noticeable up close. It has made me rethink the operation. Sinn told me the operation is done differently now compared to when Earl had it, and that the scar should not be a problem. But I am skeptical. The way I see it I will probably need makeup for atleast a year to hide the scar and try to to fade it out with silicone gel and bio-oil early on with laser/fractional/steroid treatment later

[kavan]

Does seem like they need close access near the eye to lift the eyeball out of the way in order to make the bone cut.

[Dogmatix]

But the mod L3 doesn't move the teeth.

Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?

[Dogmatix]

I also asked about doing the operation intraorally to hide the scar.

Is it even possible to anatomically access this area intraorally?

[Lazlo]

Is it even possible to anatomically access this area intraorally?

The prospect of a scar from this really scares me. It would be in a very visible area.

[PloskoPlus]

But the mod L3 doesn't move the teeth.

Heggie's does.  I think the main difference between mod LF3 and LF3 is whether the nose is involved, and WRT LF2 vs LF3 - LF3 goes further up the lateral rim, LF2 doesn't.  Sinn's surgery is mod LF3 minus the alveolar process (teeth), which is basically infraorbital and lateral rims.  And that's what he calls it most of the time - "infraorbital rim advancement," because there is not much left of the LF3 once you take away the nose and the maxilla.

[micjawsurgery]

Sinn says he uses a hidden suture technique now and makes a smaller incision. But yeah the scar is a real put off for me

[Lazlo]

Sinn says he uses a hidden suture technique now and makes a smaller incision. But yeah the scar is a real put off for me

There've been a few more people who have had it since. They also have scarring?

[kavan]

Heggie's does.  I think the main difference between mod LF3 and LF3 is whether the nose is involved, and WRT LF2 vs LF3 - LF3 goes further up the lateral rim, LF2 doesn't.  Sinn's surgery is mod LF3 minus the alveolar process (teeth), which is basically infraorbital and lateral rims.  And that's what he calls it most of the time - "infraorbital rim advancement," because there is not much left of the LF3 once you take away the nose and the maxilla.

So, it's kind of like I said on this string where the mod L3 is like what's left over after the Lefort 2 area is subtracted from the Lefort 3 area..

[kavan]

Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?

I've already given an explanation of the mod L3. Try to visualize it more based on the diagrams.

[PloskoPlus]

Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?

Yes, Sinn's surgery is bilateral - the 2 sides are moved independently.  IMO, it's a better approach because often the 2 sides can be quite different and the movements are not constrained by any occlusion considerations.

[PloskoPlus]

Is it even possible to anatomically access this area intraorally?

Wolford does it all through the mouth.  Some surgeons say he cannot possibly go far enough laterally with this approach, others just freak out.

[forwardgrowth]

How bad is the scaring , anybody have a picture?