Correction Of Vertical Maxillary Excess Research Articles

Comparative evaluation of use of reciprocating saw and bur in Le fort I osteotomy for superior repositioning of maxilla: A cross-sectional study

BackgroundTraditionally bur has been used to carry out osteotomy. In a developing country like India, the cost of surgical treatment is the important factor in determining treatment plan. Although the use of bur is cost-effective and efficient, with the advent of newer technology, it is getting replaced with a saw. AimTo evaluate and compare the use of reciprocating saw and bur in Le Fort I Osteotomy for superior repositioning of the maxilla. Materials and MethodsPatients referred from the Department of Orthodontics for the surgical correction of vertical maxillary excess (VME). They were divided into two groups. In group I, osteotomy was performed with Synthes Reciprocating Saw and in group II, bur was used. The parameters recorded in both the groups were time required for the completion of down-fracture, precision of the osteotomy cut (margins of the cut), and ease of superior repositioning. Data was collected from both the groups for comparison. ResultsA total of 14 patients with VME were included in the study. They were divided into two groups. Seven study participants were allotted to each group. In group I, Synthes Reciprocating Saw was used while in group II, a bur was used to carry out the osteotomy cut. In group I, the average time required to complete the down-fracture of the maxilla was 3.5–4 min while in group II it was more than 8 min. The margins of the osteotomy cut were smooth and regular and there was bone-to-bone contact during superior repositioning in Group I. ConclusionThe combination of the use of a saw for inferior osteotomy and a bur for the superior cut would be more beneficial in the superior repositioning of the maxilla.

Quantitative Prediction of Change in Chin Position in Le Fort I Impaction.

Vertical maxillary excess, a dentofacial deformity present in a large proportion of population impute an increased lower facial height due to increased maxillary height. This results in a clockwise rotation in the mandible, and the chin advances posteriorly and inferiorly. Le Fort I superior repositioning of the maxilla begets movement of pogonion point anteriorly and cranially. Cephalometric analysis helps to access change in position of chin following Le Fort I impaction. In our study, from this analysis a formula was defined to perceive the exact amount of this change in chin position along the vertical and sagittal plane as a result of autorotation. This experimental study assessed 45 patients with vertical maxillary excess over a period of 2years and 6months (January 2016-May 2018) in Government Medical College Hospital, Kottayam, Kerala, India. The planned procedure was Le Fort I superior impaction for correction of vertical maxillary excess. Pre-operative cephalograph was taken initially. Post-operative cephalograph after 3months was then compared with initial pre-operative cephalograph to assess the change in position of the pogonion and menton. Forty-five participants were studied. The multiple regression model was applied to predict the changes in the chin (dependent factor) according to the vertical change in the maxilla (predictive factor). For every 1mm change in the maxilla vertically, the chin was estimated to move 0.59 vertically. For a standard deviation increase of 1 in the position of the maxilla, the chin moved superiorly by 0.744 of the standard deviation. For every 1mm of vertical change in the maxilla, the chin could be expected to move 0.22mm horizontally. For a standard deviation increase of 1 in the maxillary position, the chin advanced by 0.273 of the standard deviation. This study draws to a conclusive finding that the movement of maxilla in the superior direction has an effect on the repositioning of the chin in the anterior and cranial directions. This has led to a formulation that 1mm of superior impaction of maxilla results in 0.6mm of vertical and 0.2mm of sagittal movement of chin. This might help to have a glance of future chin position and aid in deciding the need for mandibular surgery.

Sequencing of bimaxillary surgery in the correction of vertical maxillary excess: retrospective study

The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. The precision of the maxillomandibular repositioning was determined by comparison of the digital prediction and postoperative tracings superimposed on the cranial base. The data were tabulated and analyzed statistically. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy for A-point and the upper incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for aesthetics.

Surgical correction of vertical maxillary excess associated with mandibular self-rotation

Introduction: The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJremained asymptomatic after 9 months of postoperative follow-up.

Surgical correction of vertical maxillary excess associated with mandibular self-rotation

The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJ remained asymptomatic after 9 months of postoperative follow-up.

Longitudinal changes in muscle activity of masseter and anterior temporalis before and after Lefort I osteotomies, An EMG study.

Aims:The aim of this study was to compare the levels of electromyography (EMG) activity of masseter and anterior temporalis present presurgically with changes in the intensity of muscle activity that took place post surgically for a period of 6 months follow up.Settings and Design:Ten patients with vertical maxillary excess were selected from the department of Oral and Maxillofacial surgery at Saveetha Dental College and Hospitals, Chennai.Materials and Methods:Electromyography was used as a kinesiology tool to study muscle function of Masseter and Anterior Temporalis of all ten subjects pre surgically and post surgically with a 6 month follow up.Statistical Analysis Used:The statistical package SPSSPC+ (Statistical Package for Social Science, Version 4.0.1) was used for statistical analysis. Mean and standard deviation were estimated from the sample. The tests that were used for the statistical analysis were one way ANOVA and student's T test.Results:The final inference elucidates that the muscular activity of masseter and temporalis are improved during chewing and clenching in the postoperative 6 months period when compared to preoperative values. The duration was constant at 7 milliseconds for both the positions.Conclusions:From this study, it can be concluded that there is a strong correlation between vertical maxillary excess and associated weak musculature. Electromyography has been used as an important tool to demonstrate improved muscle activity after surgical correction of vertical maxillary excess and improvement in functional deficits associated with this dentofacial deformity. From this study it can be concluded that surgical correction of vertical maxillary excess improves occlusion, leading to increased eccentric tooth contacts, increased mean amplitude and increased mean power frequency of the muscles all of which translate into improved muscle activity.

Correction of anterior open bite in a case of achondroplasia

Treatment planning for patients with skeletal deformities is often considered challenging. This article reports a female patient with achondroplasia who presented with severe maxillary retrognathism and vertical excess along with anterior open bite. The clinical and cephalometric findings of the patient are detailed here. The treatment plan consisted of modified anterior maxillary osteotomy for simultaneous vertical and sagittal augmentation along with orthodontic intervention. The course of surgical-orthodontic treatment and the results are presented. This treatment is to be followed by correction of vertical maxillary excess after completion of growth. This paper concludes that the dentoalveolar component of a skeletal deformity can be handled independent of the craniofacial management.

Functional and morphologic alterations secondary to superior repositioning of the maxilla

Purpose: The purpose of this investigation was to 1) compare morphological characteristics and functional performance of a sample of patients with vertical maxillary excess (VME) with controls, and to 2) examine how the patients' oral motor function adapts to surgery. Materials and Methods: Fifteen female VME patients were compared with 26 female controls before and up to 3 years after maxillary intrusion surgery. Measures of skeletal morphology, mandibular range of motion, maximum isometric bite force, and levels of electromyogram (EMG) activity in some of the muscles of mastication were made on all subjects over time. One-way analysis of variance (ANOVA) was used to compare the controls with the patients before and after surgery. Univariate repeated measures ANOVA was used to study longitudinal changes in the patients. Results: Preoperatively, the patients possessed morphological measurements characteristic of vertical maxillary excess. Superior repositioning of the maxilla averaged 3.3 mm. Concurrently, most skeletal measures were brought closer to normal values. Masseter muscle mechanical advantage was significantly lower in the patients than in controls both before and after surgery ( P < .05). There was no significant difference between patients and controls for other biomechanical measurements. Mandibular hypomobility was apparent at 6 weeks after surgery, but returned to control values within 6 to 12 months. Before surgery, the patients had maximum isometric bite forces significantly less than those of controls. Bite forces steadily increased after surgery, approaching normal values within 2 years. Before surgery the patients' muscle activity levels per unit of bite forces were equivalent to those of controls or somewhat lower. After surgery some of the patients' muscles had significantly lower levels of muscle activity per unit of bite force than did controls. Conclusions: The results of this study suggest that correction of vertical maxillary excess with maxillary intrusion surgery improves some characteristic functional deficits.

Masseter muscle adaptation following surgical correction of vertical maxillary excess

This study was designed to examine the adaptive response of the human masseter muscle following surgical correction of abnormal facial form. Biopsies of the deep surface of the anterior superficial masseter muscle were obtained from five patients demonstrating vertical maxillary excess (VME), one at the time of corrective surgery, and a second at a long-term postoperative time interval (mean, 8 months). Control biopsies were also obtained from five individuals (three cadavers and two patients) with normal dentofacial morphology. A standard regimen of histologic and histochemical staining was used to classify individual muscle fibers as either type 1, type 2, or intermediate. In both VME patients and normal subjects type 1 fibers predominated, with the control group displaying a higher percentage (50% vs. 43%). On the average, type 1 fibers also had the largest areas. Following surgery there was an increase in type 2 fibers (30% vs. 52%). Two patients reciving maxillary surgery only exhibited either no change in mean fiber area or only a slight increase. The three remaining patients who underwent concomitant maxillary and mandibular surgery all showed a significant decrease in mean fiber area. Two persons in the latter group also showed features consistent with a denervation-reinnervation process. The results of this study indicate that the human masseter responds to surgical manipulation of the jaws in a histochemically demonstrable manner, with the nature and magnitude of the response associated with the particular surgical procedure(s) performed.

Surgical orthodontics and the temporomandibular joint: I. Superior repositioning of the maxilla

Ten randomly selected adults who had undergone orthodontic treatment and isolated superior repositioning of the maxilla for vertical maxillary excess (VME) were evaluated clinically and radiographically (mean, 48.7 months postsurgery) for signs and symptoms of masticatory and temporomandibular joint dysfunction. The patients ranged from 18 years to 37 years of age (mean, 26.2 years) when evaluated. A three-part evaluation of the subjects was performed. This consisted of an anamnestic evaluation (previous medical history), a clinical examination, and a radiographic evaluation. The anamnestic evaluation revealed that, prior to surgery, facial pain was reported by one patient and was not present in any of the patients upon follow-up examination. We believed that the pain was not related to the masticatory musculature and/or the temporomandibular joint. No patients reported pain or sounds in their joints preoperatively, while 30 percent ( 3 10 ) of the patients related a history of temporomandibular joint sounds immediately after release of intermaxillary fixation, which subsequently was reported to have resolved in all instances without treatment. Clinical examination of the temporomandibular joints at the time of recall evaluated mandibular movements and the presence of pain or sounds during joint function. These examinations revealed that clinical measures of mandibular movements were somewhat reduced relative to normal. All patients were free of temporomandibular joint and masticatory muscle pain during function, upon contralateral masticatory loading, and upon palpation. Fifteen percent ( 3 20 ) of the joints examined demonstrated sounds (popping or crepitation) via auscultation. Masticatory loading in the contralateral premolar region did not induce noise in any of the joints examined. Cephalometric laminagraphic radiographs were obtained of each of the twenty temporomandibular joints with the mandible in three positions; maximum intercuspation, mandibular rest position, and maximal opening. Numerous anatomic relations were quantified from these radiographs. However, only three parameters (condylar position, movement, and evidence of arthrosis) were compared to normative data available in the literature. These comparative data suggested that persons who had undergone orthodontic treatment in conjunction with superior maxillary repositioning demonstrated (1) a relatively retropositional condyle within the fossa and (2) reduced condylar movement during maximal mandibular opening. Two of twenty temporomandibular joints demonstrated radiographic evidence of arthrosis; one condyle demonstrated articular surface erosions, and another exhibited articular surface sclerosis. The overall incidence of arthrosis was not much greater than normal, with 20 percent ( 4 20 ) of the joints demonstrating a reduced interarticular joint space. Overall, the clinical findings revealed a low incidence of pathologic masticatory muscle and temporomandibular joint symptoms and signs compared to normative data in the literature. However, the cephalometric laminographic findings suggest the need for prospective evaluation of the temporomandibular joints in persons undergoing surgical-orthodontic correction of vertical maxillary excess.

The surgical correction of vertical maxillary excess (long face syndrome)

The surgical correction of vertical maxillary excess (long face syndrome)

Surgical correction of vertical maxillary excess: A reevaluation : Maloney F, West RA, McNeil RW. J Maxillofac Surg 10:84, 1982

Surgical correction of vertical maxillary excess: A reevaluation : Maloney F, West RA, McNeil RW. J Maxillofac Surg 10:84, 1982

Bones and Joints: Surgical correction of vertical maxillary excess. A re-evaluation

Bones and Joints: Surgical correction of vertical maxillary excess. A re-evaluation

Cephalometric treatment planning for superior repositioning of the maxilla and concomitant mandibular advancement.

Summary Cephalometric prediction tracings are used in concert with biomechanical modelling to simulate jaw movements and soft tissue profile changes associated with the surgical correction of vertical maxillary excess and absolute mandibular deficiency. Cephalometric prediction studies are used to identify positional changes which have a known propensity to relapse or be stable and when used in concert with biomechanical modelling, serve as an adjunct in designing surgical procedures to achieve skeletal stability, good facial profile aesthetics, biomechanical efficiency and long-term skeletal stability.

Life-threatening hemorrhage from a Le Fort I osteotomy

On July 29, 1980, a healthy 32-year-old white woman was admitted to the Oral and Maxillofacial Surgery Service of another hospital for correction of vertical maxillary excess and mandibular retrognathia. This was to be accomplished via Le Fort I osteotomy and mandibular autorotation. The review of systems, past medical history, and past surgical history was noncontributory. Physical examination was significant for vertical maxillary excess, increased lower facial height, mandibular retrognathia, and lip incompetence. The remainder of her examination was unremarkable. On July 30, 1980, the patient was taken to the operating room, where. under general nasoendotracheal anesthesia. a Le Fort I osteotomy was accomplished by incorporating a bilateral 8 mm ostectomy posteriorly and a bilateral 6 mm ostectomy anteriorly. The osteotomies were made with a reciprocating saw. The lateral nasal walls and nasal septum were sectioned with a forked nasal gouge and the bilateral pterygomaxillary dysjunction was effected with a curved osteotome. No significant bleeding was encountered to this time. Manipulation of the maxilla into a down-fractured position was attended with profuse arterial hemorrhage from the right posterior region. Attempts to visualize the source of the bleeding were unsuccessful. Immediate measures to stabilize the patient included multiple arterial and venous cutdowns, infusion of 15 units of packed erythrocytes, two units of autologous whole blood, four units of plasmanate, and four units of fresh frozen plasma. The right external carotid artery was

Surgical correction of vertical maxillary excess: A re-evaluation

Correction of vertical maxillary excess by Le Fort I osteotomy has become a widely accepted practice. Although the downfracture method is used almost exclusively in most major centres, the total maxillary alveolar osteotomy still has its advocates. Two patients surgically treated by total maxillary alveolar osteotomy and presented in this journal are re-evaluated with respect to the long-term stability of maxillary intrusion. Literature pertaining to the stability of the maxilla following intrusion by Le Fort I osteotomy and after various combinations of anterior and posterior maxillary ostectomy is reviewed. The advantages of the downfracture method are discussed. An alternative method of achieving the desired degree of intrusion is presented, which ensures more intimate bone contact.

Cephalometric treatment planning for superior repositioning of the maxilla and concomitant mandibular advancement

Cephalometric prediction tracings are used in concert with biomechanical modelling to simulate jaw movements and soft tissue profile changes associated with the surgical correction of vertical maxillary excess and absolute mandibular deficiency. Cephalometric prediction studies are used to identify positional changes which have a known propensity to relapse or be stable and when used in concert with biomechanical modelling, serve as an adjunct in designing surgical procedures to achieve skeletal stability, good facial profile aesthetics, biomechanical efficiency and long-term skeletal stability.

Surgical-orthodontic correction of vertical maxillary excess

Superior repositioning of the maxilla via maxillary ostectomy has proved to be useful method of treating patients with vertical maxillary excess. It is indicated primarily in patients with lip incompetence, excessive exposure of maxillary anterior teeth, long lower facial height, contour-deficient chin, and either Class I or Class II malocclusion. We have used this procedure as routine treatment for vertical maxillary excess over the past 5 years. Timing of the surgery is not so important in non-open-bite patients, and the procedure can be done with equal success before any orthodontic intervention, during orthodontic treatment, and following all orthodontic procedures. Timing is primarily dependent upon the orthodontist's desires. Since the surgery can produce a much simpler orthodontic problem, thus reducing treatment time and allowing a better over-all result, we recommend that it be done as early in treatment as possible. Clinically, the over-all improvement in facial appearance and the predictability and stability of the results have made this a most versatile and effective procedure when carried out with good planning, proper execution and attention to detail.