Modified Lefort 3 Cut by Sinn

[micjawsurgery]

Dr. Sinn sent me the cut he makes for the modified lefort 3. From the looks of it, it should solve a lot of problems with the lower orbits and cheekbones. Goes beyond the infraorbital foramen if im looking at this correctly, so the augmentation reaches close to the nasal structures and includes a good amount of the frontal process of the maxilla. I was worried only the zygoma bone and its respective orbit would be moved.

8mm of augmentation with this cut should be very good. When I was consulting with him he mentioned how the cut can't be too close to the nasal structures due to increased risk of damaging nerves, which is what I was worried about. I will be making the deposit and the payment for the CT model this week.

Any thoughts? Keeping in mind he can also move this area up 2-3mm and to the side by 2-3mm, it seems like a pretty great procedure for the midface. I’ve seen the cuts for the zso and zsso and was not impressed. Implants could provide even more augmentation closer to the nasal base which I was considering as an alternative, but I am pretty commited to this surgery now. He can also add some HA beyond the cut if augmentation is needed closer to the nose

the ZSO cut is on the right here: https://api.intechopen.com/media/chapter/48013/media/image16.jpeg

I plan to provide some visual update in August after my surgery heals up

[forwardgrowth]

He can provide 3mm of anterior movement via HA Granules? Have you looked into MSE+Facemask? Also very effective if you stack these two together you could get good results for frontal maxilla, orbitals, etc

[micjawsurgery]

From my understanding he can add HA onto the bone that is being moved (move the cut forward 8mm, add another 2-3mm of HA), and also near the nose where the bone is not being moved to reduce the visual stepoff that occurs.

I also haven't looked into MSE+facemask and don't plan to. My lower maxilla is very forward so I don't need augmentation there. My upper maxilla and cheeks didnt grow forward as much so this procedure is very close to ideal at augmenting the regions I need. A wider palate would be nice though

[forwardgrowth]

I see..HA applied to nose area meaning close to frontal maxilla? Also have you reach out to Dr. Wolfe in Flordia about his malar osteomony he offers.

I see with MSE+Facemask you can protract and bring upper maxilla forward but a long process

also based off the picture the cut on orbital rim ends not completely at the top of the bone, why is that

[micjawsurgery]

In the picture I provided HA would be added to the left of the cut, beyond the marker line. No I haven't talked to any other surgeons. I am not interested in a malar ostetomy since one of my main aesthetic goals is to move the rims forward and reduce the shadowing  and protrusion under my eyes.

[kavan]

It would be easier to appreciate in entirety with relation to the rest of the skull if the photo were not so cut off. But your description is good.

Does he explain how he gets the eye ball out of the way in order to make the cut WITHIN the ORBIT?

[micjawsurgery]

Yeah I had to run it side by side with a complete picture of the skull to understand the cuts. I think he may be cutting from underneath? I will ask him since I am rather curious too. Didn’t grill him on technical details since hes done the surgery many times before

[kavan]

Yeah I had to run it side by side with a complete picture of the skull to understand the cuts. I think he may be cutting from underneath? I will ask him since I am rather curious too. Didn’t grill him on technical details since hes done the surgery many times before

I THINK--not sure--the operation he does is after an Andrew Hegge (Australian maxfax) who wrote about modified L3 (like in early 1990s). But each time I try to use Google to read that particular paper, it kicks up sites that want me to sign up using Google account, FB account --basically info I don't feel like sharing just to read that paper because I don't want to risk my edu account being spammed.  Anyway, if you can get a hold of the paper of mod L3 by that doctor's name, it might have more details about how they do the op.

[Dogmatix]

It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?

[PloskoPlus]

It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?

Lf3 lengthens the nose as well. A coronal incision is used as well. It's a much more invasive surgery.

[PloskoPlus]

I THINK--not sure--the operation he does is after an Andrew Hegge (Australian maxfax) who wrote about modified L3 (like in early 1990s). But each time I try to use Google to read that particular paper, it kicks up sites that want me to sign up using Google account, FB account --basically info I don't feel like sharing just to read that paper because I don't want to risk my edu account being spammed.  Anyway, if you can get a hold of the paper of mod L3 by that doctor's name, it might have more details about how they do the op.

No, it's not that paper. Heggies lf3 affects the occlusion as well.  I think it's this one  https://www.joms.org/article/0278-2391(95)90732-7/pdf

[Dogmatix]

Lf3 lengthens the nose as well. A coronal incision is used as well. It's a much more invasive surgery.

This is the understanding I have of different lefot cuts.
http://static.wixstatic.com/media/92282f_6749a581803047dbadf34613a49fdb40~mv2.jpg

When I google coronal incision, this is what I get.
https://dp11i9uvzjqmt.cloudfront.net/2/images/upload-flashcards/98/62/68/3986268_m.jpg

You mean that normal lefort III goes this high?

How do you mean that the nose is handled in a modified lefort III? From my first picture it looks like the whole point with lefort II/III is to have the nose included as well. How can the nose be moved any differently with modified cuts?

[kavan]

It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?

Well, if you Google for a diagram Lefort3, you see it takes a large chunk of the frontal face, including the Lefort 1 area and L2 with it.  The mod L3 people usually refer to (the one that Earl got) is basically the lower orbital rim area and some cheek bone area. If you can get a hold of the paper I mentioned in this thread, it would probably detail more about it.

Here's a link to Leforts. http://faculty.washington.edu/jeff8rob/wordpress/wp-content/uploads/2017/02/Lefort-1024x576.jpg

In GENERAL--and this is only in general-- a mod L3 is what's left over after you SUBTRACT the 'Type 2' area from the 'Type 3' area. That's the only way I can even attempt to describe it verbally to you. But it's one of those things that requires 'visual' skills to subtract type 2 from the type 3 diagram to 'see' (in your head) what's left over.

Here's a 'fun fact'. The 3 basic Leforts were named after Renee Lefort who SMASHED SKULLS--lots of them--against the wall where he noted the most common fracture lines. So, when he smashed them against the wall, the 3 most common ways they BROKE are described as 'L1', 'L2' and 'L3'. But of course, with some surgical skill--and modern equipment--a doctor doesn't have to perform a surgery along the fracture lines that commonly get kicked up subsequent to smashing a skull against the wall. Instead, he can selectively just cut into the parts he wants to move around. So, say he only wants to move the parts of Type 3 that are LEFT OVER after the Type 2 part is SUBTRACTED from the Type 3. That's an example of a 'modified L3'. If there are still some parts after that that he doesn't want to move, it's still a modified l3.

So, basically, a modified L3 is an L3 that DOES NOT include the L2 area. That's the easiest way to describe it in general. But the ONLY thing that describes SPECIFICALLY what a doc does who calls what he does a 'modified L3' is a diagram or a specific model of WHERE he is making the cuts as to the specific area to be released.

[kavan]

No, it's not that paper. Heggies lf3 affects the occlusion as well.  I think it's this one  https://www.joms.org/article/0278-2391(95)90732-7/pdf

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.

[Dogmatix]

Here's a 'fun fact'. The 3 basic Leforts were named after Renee Lefort who SMASHED SKULLS--lots of them--against the wall where he noted the most common fracture lines. So, when he smashed them against the wall, the 3 most common ways they BROKE are described as 'L1', 'L2' and 'L3'. But of course, with some surgical skill--and modern equipment--a doctor doesn't have to perform a surgery along the fracture lines that commonly get kicked up subsequent to smashing a skull against the wall.

It's hard to decide for jaw surgery with today's modern technology. Can imagine how hard it was before it was discovered that you don't have to smash the head against a wall to create the fractures