Safe Maxillary Segmentation in Le Fort I Osteotomy. A Technical Note

Maxillary segmentation during Le Fort I osteotomy enables complex 3-dimensional repositioning, facilitating transverse expansion, vertical modification, and dentoalveolar torque adjustment. However, its execution remains controversial due to the risk of periodontal, dental, and vascular complications related to the location and design of the interradicular osteotomy. The aim of this technical note is to describe a standardized and safe protocol for maxillary segmentation based on the use of piezoelectric technology. The technique proposes bilateral segmentation between the canine and lateral incisor following orthodontic preparation to increase root divergence. An "H-pattern" osteotomy is used to define 2 lateral segments, an anterior segment (premaxilla), and an intermediate bony island, allowing independent mobilization. The surgical sequence includes controlled osteotomies performed with a piezoelectric device, direct visualization of the nasal floor, and progressive deepening toward the palatal cortex before completing the crestal separation. This protocol, systematically applied since 2014, has improved surgical control, preserved bone vascularization, and reduced the risk of periodontal injury. Protocolized maxillary segmentation using piezoelectric technology represents a safe, reproducible, and efficient approach to optimize outcomes in orthognathic surgery involving Le Fort I segmentation.