#461: Le Fort Osteotomy: Nursing Care Using the LATTE Framework

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The Le Fort surgery (AKA Le Fort Osteotomy) is utilized to correct midface abnormalities including maxillary asymmetry, malocclusion, protrusion (overbite or underbite), and facial fractures. It may even be utilized to enlarge the upper airway to treat obstructive sleep apnea. In some cases, a Le Fort procedure is used to improve surgical access for tumor removal at the base of the skull.

There are three types of Le Fort osteotomy (LFO):

• Le Fort I – This is the most common type of LFO and it is primarily used to improve the bite and shape of the face. It involves a horizontal cut above the teeth to separate the upper jaw from the rest of the skull. The jaw is then repositioned and secured into place.
• Le Fort II – In this procedure, the nose and upper jaw are moved together. 
• Le Fort III – This procedure involves moving the entire midface, even parts of the eye sockets, forward. This procedure is utilized to correct significant deformities and facial trauma.
• A combined Le Fort I, II and III – To treat severe midface underdevelopment (hypoplasia), this complex surgery combines all levels of LFO to divide the midface into multiple segments which are repositioned individually.

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L: How does the patient LOOK?

Prior to surgery, how the patient looks and what signs/symptoms they exhibit will vary depending on their particular abnormality. For example, they could have pain with chewing, inability to align teeth, or difficulty breathing through the nose. 

After the le fort osteotomy surgery: 

• Jaw wired closed
• Swelling of the mid and lower face
• Oozing of blood is common
• A head-and-chin wrap that anchors at the top of the head and provides upward support beneath the jaw
• Some patients may have a device that provides continuous cold therapy while also providing compression and jaw support

A: How do you ASSESS the patient after Le Fort surgery?

Whenever you are caring for a patient after any surgery involving the nose, oral cavity or neck, you should be monitoring their airway very, very closely for any signs of compromise. This can include inability to clear secretions, stridor, and even loud snoring. Other key assessments include: 

• Spo2 – Hypoxia can occur due to airway occlusion and hypoventilation associated with anesthetic agents and opioids.
• Pain level – The procedure can be quite painful, especially when more complex LFOs performed. In addition, a headache could be associated with a CSF leak.
• Sedation level – Keep a close eye on sedation level, and administer opioids carefully.
• Swallowing ability – Damage to facial nerves can occur during the procedure. If your patient is drooling excessively, this could be a sign that swallowing is impaired.
• Frequent swallowing – Frequent swallowing may be related to excessive bleeding from the surgical site(s). 
• Nausea – Monitor the patient for nausea as jaw immobilization puts them at high risk for aspiration.
• Cranial nerve assessment – Cranial nerves can be damaged with any facial trauma, including the Le Fort procedure. A study conducted in 2018 showed that the main nerve affected is the trigeminal nerve, followed by oculomotor, abducens, optic, facial, vagus, and accessory nerves. 
• Bleeding – Monitor for signs of bleeding, just as you would with any surgical patient.
• CSF leak – Cerebrospinal fluid leaks can occur after Le Fort osteotomy. Remember, CSF is a colorless fluid, so if you see fluid leaking from the nasal cavity or ear, it should be tested to determine if it is CSF. The halo sign can be tested for by placing a drop of the fluid onto a piece of gauze. If there is a mix of blood and CSF, the blood will clot in the center with the CSF forming a halo around it. 

T: What TESTS are utilized in the care of this patient?

• Imaging studies – Prior to surgery, imaging studies include x-ray and CT scan of the facial bones. 
• CSF testing – For definitive results, samples of suspected CSF can be sent to the lab for a beta-2 transferrin test.
• CBC – Monitors for blood loss and signs of infection.
• Coagulation studies – Helpful in determining bleeding risk in trauma patients.

T: What TREATMENTS are utilized

• Suctioning – Frequent suctioning can help keep the airway clear and provide information on level of bleeding. It may be difficult and painful to use a stiff Yankauer for oral suctioning, so a nurse hack is to utilize the thin, flexible tubing used to suction tracheostomies instead.
• Positioning – Maintaining the patient in an upright position reduces swelling and risk of aspiration.
• Pain management – Multimodal pain interventions combine compression, ice, opioids, acetaminophen and NSAIDs to manage pain without compromising respiratory function.
• Nausea – Since vomiting with an immobilized jaw is an emergent situation that can lead to airway occlusion and aspiration of stomach contents, nausea should be treated aggressively and, ideally, avoided altogether. Medications such as ondansetron, metoclopramide, scopolamine, dexamethasone, and promethazine are all medications that have an antiemetic effect. If the patient vomits and cannot clear their airway, the wires must be cut immediately. 
• Fluid replacement – The patient will have a difficult time taking in fluids initially so IV fluid replacement may be necessary in the immediate postoperative period.
• Supplemental oxygen – Utilize supplemental as needed to maintain levels above MD ordered parameters (usually > 92%).
• Clear liquid diet – The patient will initially be on a clear liquid diet advancing to a full liquid diet by time of discharge. 
• Oral hygiene – Keep the oral cavity clean with oral hygiene products that won’t cause irritation or damage to sutures. In the clinical setting, sponge swabs and disinfectant mouthwash are recommended
• Communication – Since it will be difficult for the patient to speak, provide alternative communication formats such as a whiteboard or notepad.

E: What EDUCATION will be provided? 

Since patients will often have their wires or elastics in place for several weeks after surgery, there is a lot of education that should be provided prior to discharge. 

General education

• Blood clots in the sinuses are common after Le Fort I surgery and will clear out slowly over the few weeks. It is very important that the patient avoid blowing their nose for at least two weeks. Saline nasal spray can help keep the nose clear. 
• Sneeze with the mouth open as much as possible to reduce pressure in the nasal cavity. 
• No flying, swimming, or scuba diving until cleared by the surgeon.
• Avoid strenuous activities and contact sports until cleared by surgeon (generally 4-6 weeks).
• The sutures will dissolve and fall out on their own, which typically takes 4 to 5 weeks.
• If swallowing pills is a concern, ask the physician to prescribe liquid formulations.
• Avoid smoking for at least 4 to 6 weeks. A nicotine patch may be prescribed if needed.

Diet

• Maintain a liquid or pureed diet for 4 to 6 weeks after surgery.
• Be mindful of calories to avoid losing too much weight. 
• Avoid using a straw as this can dislodge blood clots, disrupt the stitches, damage the surgical site and delay healing. Instead, use a feeding syringe initially and then sip from a cup as soon as able.

Oral hygiene

• Rinse with physician approved mouthwash as directed (two to three times per day).
• Brush teeth gently with a soft toothbrush; an infant toothbrush works well for this. Avoid brushing incision lines.
• If elastics are in place, some surgeons may advise they can be removed for brushing and replaced afterward. In other cases, the elastics should stay in place.

Pain control

• Sleep with head elevated to reduce swelling.
• If the patient does not have a cold therapy device, ice packs can be used for 20-minutes at a time.
• Take prescribed pain medications as ordered. In general, the pain is most significant in the first 2 to 3 days after surgery. After that, pain can typically be managed with NSAIDs and acetaminophen.
• Numbness in the lower and upper lips is common after jaw surgery and it can take 6 to 12 months for the nerves to heal. A feeling of “pins and needles” is a sign nerves are recovering.

Nausea

• Nausea can occur after surgery due to blood being swallowed and opioid pain medications. Antiemetics and sips of clear soda can help. This is another reason to adhere to the liquid diet so that if the patient does vomit, it will flow out through the mouth. It is important that if the patient does vomit, they should assume an upright, head-forward position to prevent aspiration.

When to call the MD

• Signs of infection such as foul-smelling drainage or odor, unrelieved pain, warmth/redness at the site, and elevated temperature (over 101.5° F).
• Pain that worsens or is unrelieved by medication.
• Suspected aspiration, which can lead to pneumonia.
• Excessive sleepiness, especially with opioid use.
• Any concerning neurological symptoms such as vision changes, difficulty speaking or impaired swallowing.
• Continuous clear drainage from the nose (possible CSF leak, especially with persistent headache).

So there you have it…your quick guide to caring for a patient after a Le Fort osteotomy. Looking for more post-op guides? Check out this one and this one!

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The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

References:

Children’s Hospital of Philadelphia. (n.d.). Surgical Management of Craniofacial Conditions. Children’s Hospital of Philadelphia. https://www.chop.edu/treatments/surgical-management-craniofacial-conditions

dos Santos Alves, J. M., de Freitas Alves, B. W., de Figueiredo Costa, A. C., Carneiro, B. G. D. S., de Sousa, L. M., & Gondim, D. V. (2019). Cranial nerve injuries in Le Fort I osteotomy: A systematic review. International Journal of Oral and Maxillofacial Surgery, 48(5), 601–611. https://doi.org/10.1016/j.ijom.2018.11.012

Hauser, J. M., Azzam, J. S., & Kasi, A. (2025). Antiemetic Medications. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532303/

Kim, J.-W., Chin, B.-R., Park, H.-S., Lee, S.-H., & Kwon, T.-G. (2011). Cranial nerve injury after Le Fort I osteotomy. International Journal of Oral and Maxillofacial Surgery, 40(3), 327–329. https://doi.org/10.1016/j.ijom.2010.09.008

Kroeker, A., Edwards, S., Sullivan, S., & McKean, E. M. (2012). Cerebrospinal Fluid Leak following LeFort I Osteotomies. Otolaryngology–Head and Neck Surgery, 147(S2), P243–P243. https://doi.org/10.1177/0194599812451426a375

Kumar, J. N., & Ravi, P. (2020). Postoperative Care of the Maxillofacial Surgery Patient. Oral and Maxillofacial Surgery for the Clinician, 239–255. https://doi.org/10.1007/978-981-15-1346-6_12

Moorhead, A., Winters, R., & Serra, M. (2025). Le Fort Osteotomy. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK564372/

Woo, D. A. (2018, August 22). Lefort maxillary advancement post-operative patient instructions. Hasbro Children’s Hospital. https://www.brownhealth.org/sites/default/files/lifespan-files/documents/centers/cleft-craniofacial-center/lefort-maxillary-advancement.pdf

Last Updated on January 27, 2026 by Maureen Osuna, MSN, RN