Autogenous Mandibular Bone Graft for Maxillary Le Fort I Osteotomy Interpositional Gap in Orthognathic Surgery: A Technique Case Series

Correction of maxillofacial skeletal dental deformities often includes surgical interventions in the maxilla and mandible. Le Fort I maxillary osteotomies are performed to correct maxillary horizontal, vertical, and transverse discrepancies. Repositioning of the maxilla creates an interpositional gap in bone that can lead to pseudoarthrosis, instability, mobility, infection, and eventual relapse. Grafting the interpositional gap with bone creates mechanical stops to prevent relapse, provides a matrix for secondary ossification, accelerates bony union, and inhibits soft tissue herniation. This can be accomplished using autogenous bone harvested from the patient. Donor sites include the calvarium, rib, and iliac crest bone. Although these donor sites have their advantages and specific indications, they require a second surgical site, which can lead to potential complications, such as infection, donor site morbidity, pneumothorax, and gait disturbances. In conjunction with the Le Fort I maxillary osteotomy, for correction of maxillary deformities, the bilateral sagittal split mandibular osteotomy is a common procedure used for mandibular advancement, setback, and correction of mandibular asymmetry with or without concurrent genioplasty. Five patients (1 man and 4 women) underwent orthognathic surgery for correction of their maxillofacial skeletal dental deformities at the Loma Linda University Hospitals (Loma Linda, CA) from 2015 through 2017. This case series describes a technique to harvest autogenous bone from the posterior aspect of the distal sagittal split osteotomy segment of the mandible, which is milled and used to graft the interpositional gap in the maxilla. Principles of guided bone regeneration are incorporated to improve surgical outcomes.