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Can already having had a segmented LeFort allow for easier expansion later?

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The thought occurred to me recently, that if you are someone who has, in the past, had a segmented lefort procedure, would that make it easier to separate the halves of the maxilla when attempting to expand transversely?

This image below gives an idea for different ways the palate is segmented when performing such an operation:

segmented lefort

Consider if you were someone who had the simplest segmented procedure, which is the one on the right in the image above.  While the gap between the separated halves does form new bone over time afterward, I would think that this new bone would be somewhat thinner (in density) than an adult who never had any procedure performed.  That leads me to wonder if performing a new expansion later on, using MSE or even another device (such as acrylic), would be relatively easy.  This is despite having the typical plates put in place during a lefort procedure (one on each side of the pyriform rim and one along each zygomatic buttress).

I did have a 3-piece lefort when I was 19, similar to the leftmost image above.  I don’t know for sure, in my case, if the “Y” incisions went between the canines and laterals, or between canines and premolars.  I know that a 3-piece lefort is a different dynamic, but I can say for sure that whenever I used to press on the center of my palate (about where the 3 cuts intersect, at the branch of the “Y”), I used to feel and hear a clicking sensation, like the segments were rubbing about each other.  This happened up until I began my expansion regime a little under two years ago (at age 41).  I’m guessing that my new expansion has caused the original segments to move apart from each other so that they no longer touch (i.e. pressing on my palate in this area no longer “clicks”), and I guess new softer tissue filled in the new gaps.  None of this is for sure, of course, but I don’t know what else could have happened.  Also, it appears that my palate has expanded more in the posterior than the anterior, which could be explained by having had the 3-piece rather than the 2-piece.

Has anyone else here had a segmented lefort in the past, or have thoughts in general about this phenomenon?

Posted : 15/02/2021 1:27 am