Since its clinical introduction by Obwegeser in 1969 for the correction of maxillofacial deformities, the Le Fort I osteotomy has been reported as a relatively safe tool for moving the maxilla in all 3 planes of the space with some degree of segmentalization. It is widely accepted, with continually growing popularity for correcting skeletal malocclusion. However, as with any other surgical procedure, orthognathic surgery is not risk-free (Dowling et al., 2005; Bhatia et al., 2016; Mafféïs et al., 2023).

The number of clinical reports on complications after Le Fort I (LFI) orthognathic surgery has gradually increased. Temporary sensory impairment is the most commonly reported complication, followed by postoperative infection, loss of hardware, nasal deformities, intraoperative hemorrhage, and dental complications (Kramer et al., 2004; Peleg et al., 2021; Mansour et al., 2023; Choi et al., 2023).

Major complications such as skeletal relapse or maxillary avascular necrosis have been reported with large anteroposterior maxillary advancements. The literature is conflicting on this issue: some authors recommend bimaxillary surgery at the same time if maxillary advancement of more than 1 cm is required (Herber and Lehman, 1993; Hirano and Suzuki, 2001), whereas other authors (Eskenazi and Schendel, 1992) report no connections between a great amount of advancement and intraoperative/postoperative complications. The duration of the operation, comorbidities, surgical approach and surgeon's experience have been debated as possibly affecting the frequency and type of these complications.

The purpose of this study was to introduce a technical strategy in a homogeneous group of patients affected by severe hypoplastic maxilla who underwent a modified LFI osteotomy for maxillary advancement greater than 1 cm.