Two-segment le fort I osteotomy in orthognathic surgery utilizing anterior maxillary segmental osteotomy

Objective: To present a case of vertical maxillary excess managed through a modified Le Fort I osteotomy combined with anterior maxillary segmental osteotomy, addressing malocclusion, a gummy smile, and lip incompetence. Case Report: A 27-year-old female presented with habitual mouth breathing, lip incompetence, maxillary prognathism, a gummy smile, and a convex profile with a shallow labiomental fold. Despite previous extractions of teeth 36 and 46, an Angle’s Class II canine relationship was noted bilaterally, with a 5 mm overjet and 3 mm overbite. After orthodontic preparation, a Le Fort I osteotomy was combined with anterior maxillary segmental osteotomy, utilizing the extraction sockets of teeth 14 and 24 to separate the anterior and posterior segments. The segments were repositioned using a palatal splint and surgical wafer, then secured with L plates and screws. Genioplasty was performed to enhance facial aesthetics and correct lip incompetence. The patient was hospitalized for two days and received standard postoperative care, including analgesics, steroids, and antibiotics, alongside a soft diet. Results:: The combined surgical approach improved the occlusal plane, corrected incisor inclination, and resolved the gummy smile. Genioplasty enhanced the facial profile and lip competence. Follow-up examinations confirmed stable results, good occlusion, and no complications. Conclusion: This case demonstrates the efficacy of combining a segmental Le Fort I osteotomy with anterior maxillary segmental osteotomy for correcting maxillary excess and enhancing facial aesthetics. The precise segmentation of the maxilla and inclusion of genioplasty provided targeted corrections, underscoring the importance of personalized surgical planning in complex craniofacial cases.