Performing Le Fort I impaction osteotomy can be compromised or impossible. The intranasal volume of the lower turbinates prevents an important maxillary impaction. In this case, horseshoe osteotomy is an alternative.The first step is to lower the inferior edge of the pyriform aperture and the anterior floor of the nasal fossae with a bur. The palatine alveolar wall is cut through resection of the maxillary sinus anterior and lateral walls. The maxillary dental arch may be impacted without freeing the vomer or cutting through lateral walls of the nasal fossa, after having dissected the palatine fibrous mucosa and disjoined the pterygomaxillary suture.This technique has mainly been used in pre-implantation surgery to lower the maxillary crest in edentulate patients, and to increase the crestal height after bone grafting without modifying the position of the hard palate. It is a good alternative to the usual Le Fort I osteotomy for important impactions when the alveolar bone height is sufficient.