Maxillary Segmental Osteotomy Research Articles

Stability between single and segmental maxillary osteotomies in bimaxillary surgery for cleft-associated class III deformity: a CBCT study.

Segmental Le Fort I osteotomy through the cleft is a common strategy to narrow the alveolar cleft in adults. This study compared skeletal stability between single and segmental Le Fort I osteotomies in patients with unilateral cleft lip and palate (UCLP). This retrospective analysis examined 45 adults with complete UCLP-associated class III deformities who underwent bimaxillary surgery with either single (n = 30) or segmental (n = 15) Le Fort I advancement. Cone beam computed tomography (CBCT) scans of the facial skeleton were acquired before surgery, 1-week postsurgery, and at follow-up. Measures of landmarks from the CBCT images for the two treatment groups were compared for translation (left/right, posterior/anterior, superior/inferior) and rotation (yaw, roll, pitch). Postsurgery, the downward movement of the maxilla was larger in the segmental group than the single group. At follow-up, the maxilla moved backward in both groups, and upward in the segmental group. The mandible moved forward and upward and rotated upward in both groups. The amount of upward movement and rotation was larger in the segmental group than the single group. Two years after bimaxillary surgery in patients with UCLP-associated class III deformity, greater relapse was found after segmental Le Fort I osteotomies in vertical translation of the maxilla and mandible, and pitch rotation of the mandible compared with single Le Fort I osteotomies. The vertical relapse of the maxilla was larger after segmental Le Fort I advancement compared with single Le Fort I advancement in clefts.

Nasolabial soft tissue changes associated with posterior maxillary movement following anterior segmental osteotomy in skeletal Class II patients: A case series

ObjectiveThis study investigated the relationship between the external nasal morphology and hard tissue movement in patients who underwent anterior segmental maxillary osteotomy (ASMO) to correct maxillary protrusion correction. MethodsThe study enroled patients with an overjet ≥ 5 mm, and an ANB ≥ 2° who underwent ASMO with or without Le Fort I osteotomy. Linear and angular measurements were performed on computed tomography images obtained preoperatively and one year post-surgery. ResultsThe movement of the maxilla at U1 was 6.7 ± 2.9 mm backward and 1.9 ± 2.0 mm upward. Tooth axis inclination of U1 (∠U1 to FH) increased 5.5 ± 6.1°. The nasolabial angle significantly increased from 90.0 ± 16.8° to 101.0 ± 13.2°. No significant differences were observed in alar base width or nasal tip angles. The change of ∠U1 to FH and the backward movement of U1 were relevant factors influencing the change of nasolabial angle. ConclusionsThis study provides insights into the relationship between external nasal morphology and posterior movement of the anterior maxillary segment after ASMO surgery. These findings are significant for predicting post-operative patient profiles.

Accuracy of Patient-Specific Implants in Virtually Planned Segmental Le Fort I Osteotomies.

(1) Background: In orthognathic surgery, segmental Le Fort I osteotomies are a valuable method to correct maxillary deformities or transversal discrepancies. However, these procedures are technically challenging, and osteosynthesis can be prone to error. (2) Methods: In this retrospective, monocentric cohort study, patients were enrolled who underwent a virtually planned segmental maxillary osteotomy during their combined treatment. Positioning and osteosynthesis were achieved by either a 3D-printed splint and conventional miniplates or patient-specific implants (PSI). The preoperative CT data, virtual planning data, and postoperative CBCT data were segmented. The deviation of all the segments from the desired virtually planned position was measured using the analysis function of IPS CaseDesigner. (3) Results: 28 Patients in the PSI Group and 22 in the conventional groups were included. The PSI group showed significantly lower deviation from the planned position anteroposteriorly (-0.63 ± 1.62 mm vs. -1.3 ± 2.54 mm) and craniocaudally (-1.39 ± 1.59 mm vs. -2.7 ± 3.1 mm). For rotational deviations, the pitch (0.64 ± 2.59° vs. 2.91 ± 4.08°), as well as the inward rotation of the lateral segments, was positively influenced by PSI. (4). Conclusions: The presented data show that patient-specific osteosynthesis significantly reduces deviations from the preoperative plan in virtually planned cases. Transversal expansions and vertical positioning can be addressed better.

Esthetic and functional advantages of subapical anterior segmental maxillary osteotomy in treatment of dentofacial deformity

Aim This study aims to investigate the effect of anterior segmental maxillary osteotomy in treatment of maxillary prognathism with good molars occlusion. Patients and methods This study includes 20 patients diagnosed with dentofacial deformities − maxillary prognathism visiting maxillofacial surgery outpatient clinic in Assiut University Hospitals during the period between January 2017 and December 2021. Results The common complications which occur is wound infection which occur in two (10%) cases, then postoperative relapse which occur in one (5%) case, palatal mucosal tear which occur in one (5%) case, and unfavorable nasolabial esthetic which occur in one (5%) case. Conclusion Anterior segmental maxillary osteotomy is a recommended treatment modality of choice in patients with maxillary and/or dentoalveolar protrusion.

Anterior Maxillary Osteotomy Distraction Osteogenesis (Amodo) in the Treatment of Maxillary Hypoplasia in Unilateral Cleft Lip and Palate-A Case Report

Distraction osteogenesis defines a technique of bone generation by distraction of native bony segments. The technique offers a promising treatment alternative for patients with maxillary or midfacial hypolasia. In this case report, the various steps in the treatment of an 18 year old boy with premaxillary hypoplasia and anterior crossbite are described. Patient was treated with a distraction osteogenesis technique and premaxillary advancement was performed using individual tooth - borne distraction device. The surgical procedure involved an anterior segmental maxillary osteotomy respecting the palatal periosteum. Distractor was cemented in the mouth after the surgical procedures. The patient was observed during a seven day latency period after which the device was activated 0.4mm every 12 hours. The anterior crossbite was eliminated and the occlusal correction and settling was achieved with fixed orthodontic appliances.

Retention Strategies for Segmental Lefort I Osteotomies Using Clear Aligners.

Clear aligner therapy is becoming a mainstay of contemporary orthodontic treatment. As such wide-spread adoption and case-selection for surgical-orthodontic treatment in patients with Clear aligner therapy is increasing. Passive aligners generally lack adequate rigidity for retention of segmental movements in the immediate postoperative period. In this report we discuss our techniques for maintaining retention in the weeks after segmental maxillary osteotomies by use of a modified clear aligner orthognathic splint, and a custom palatal horseshoe splint, including the relative indications of each method.

Soft and Hard Tissue Changes and Facial Rejuvenation of Anterior Maxillary Segmental Osteotomy: A Three-Dimensional Cephalometric Study.

To explore the efficacy of anterior maxillary segmental osteotomy (AMSO) in reliving maxillary protrusion and better analyze the three-dimensional (3D) morphological changes of the postoperative nasolabial region using computed tomography (CT) and evaluate the trend of facial rejuvenation. Forty-five patients who underwent AMSO from January 2017 to December 2021 were retrospectively included. CT and oriented photography were performed before and 10 months after the treatment. The mimics17.0 software was used to reconstruct the 3D CT scan results before and after the operation, measure the data of each anatomical index, and systematically evaluate the soft tissue changes in the nasolabial region. The patients themselves, the plastic surgeons, family members, or friends of patients use the Face-Q Age Appraisal Visual Analogue Scale (VAS) to evaluate the changes in patients' visual age before and after the operation. Forty-five cases of maxillary protrusion were alleviated.Seen from the side, the protruding degree of the upper lip is obviously reduced.In the front view,∠Cont-Sbal-F, the width of alar base, andalae nasi all increased significantly. Contrary to traditional perceptions, the protrusion and height of the nose tip actually increased rather than decreased after AMSO. The visual age score improved positively, and patients obtained facial rejuvenation. No serious complications occurred; after 10-month follow-up, we achieved a high degree of satisfaction. AMSO can significantly improve the maxillary protrusion, and it can increase the protrusion and height of the nose tip. Also, patients can get a younger appearance. Comprehensive preoperative evaluation and postoperative nasolabial morphology with maxillary protrusion patients are helpful for correct clinical decision-making. At the same time, the operation suggests a new choice of facial rejuvenation for patients with maxillary protrusion. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Comparison of Propofol-Fentanyl Versus Propofol-Ketamine Combination as Total Intravenous Anesthesia in Maxillofacial Surgical Procedures – A Prospective Randomized Controlled Study

Background: Total intravenous anesthesia (TIVA) is a technique where drugs are administered intravenously for the induction and maintenance of anesthesia instead of volatile drugs, avoiding some of the drawbacks of inhalation anesthesia providing rapid and complete recovery making it suitable for daycare surgeries. Aim: To compare the intraoperative and postoperative hemodynamic patterns, postoperative recovery time, and unwanted consequences such as post-operative nausea and vomiting (PONV) in various maxillofacial procedures using a combination of two drug regimens, namely propofol-ketamine and propofol-fentanyl. Patient & methods: 40 patients between the age group of 18-40 years of either gender were randomly divided into two groups with propofol-ketamine (group 1, n=20) and propofol-fentanyl (group 2, n=20) who underwent various surgical procedures like cyst enucleation, open reduction and internal fixation (ORIF) of facial fractures, orthognathic procedures such as maxillary or mandibular segmental osteotomy and genioplasty with the procedure lasting 60 to 75 minutes. This study compared the total amount of propofol, time of the infusion, and hemodynamic parameters like mean pulse rate (PR), oxygen saturation level (SpO2), systolic blood pressure (SBP) & diastolic blood pressure (DBP), emergence time & recovery time, undesirable sequels like postoperative nausea and vomiting (PONV) and any other side effects between both the groups. Results were analyzed statistically using an independent t-test and chi-square test. Results: A comparison of two groups revealed a significant rise in systolic blood pressure in group 1 as compared to group 2 and group 2 showed better emergence time & recovery time with fewer incidences of postoperative nausea and vomiting and other side effects. Conclusion: Since the propofol-fentanyl provided significantly good results it can be considered as an alternative to gaseous anesthetic agents in various maxillofacial surgical procedures mentioned in the materials with the surgical procedure lasting 60-75 minutes.

Personal Guide Assisted Orthognathic Surgery: Application of a T-shaped Tooth Bone Combined Supporting Osteotomy Guide Plate and Positioning Guide Plate.

The precise movement of the maxilla is particularly important for orthognathic surgery, especially for patients with maxillary segmentation. In this preliminary study, the authors present a new tooth bone combined with a supporting osteotomy guide and positioning guide to guide the osteotomy and reduction of the maxilla. Through our preoperative simulation and postoperative image fusion, the authors found that the overlapping area is more than 90%. According to compare of the virtual plans and the postoperative results based on distances from the maxillary land- marks to the horizontal plane, sagittal plane, and coronal plane, the surgical error was about 2mm. Our T-shaped guide provides a reliable method for patients with maxillary segmental osteotomy, which may be a useful alternative to the intermediate.

Active Unilateral Condylar Hyperplasia Treated With Simultaneous Condylectomy and Orthognathic Surgery: A Clinical Report

To review and report the demographic and diagnostic data in a population with active unilateral condylar hyperplasia. The surgical intervention, sequencing of surgery, and treatment outcomes, including a quality-of-life survey, are described. Eighty patients were diagnosed with active disease. Demographic, treatment, and treatment outcomes were assessed. Quality of life was assessed by a 21-question questionnaire. Women were affected more frequently than men (W- 52; 65%; P = .008). Hemimandibular elongation (HE) (49; 61%; P - .004) occurred more frequently than hemimandibular hyperplasia (HH) (24; 30%) and HH-HE (7; 9%). Right side was affected more than left (R- 49; 61%; P - .003) overall, and when stratified. All racial groups were represented. Of the 80 patients in the sample, 80 (100%) underwent condylectomy on the side of active growth, 70 (87%) underwent bimaxillary osteotomies, 53 patients (66%) had single-piece maxillary osteotomies, 17 (21%) underwent segmental maxillary osteotomies, and 38 (48%) genioplasties were performed. Four patients (5%) underwent a second operation within a year of the first surgery to adjust the position of the mandible. Four (5%) facial nerve deficits were recorded. Class I cuspid occlusion was achieved with coincident maxillary and mandibular midlines and resolution of crossbite in 70 (88%) patients. Twenty three of the 24 respondents (96%) reported that they were satisfied with the treatment. Both HH and HE are diagnosed through clinical and radiographic examinations. Our results showed that HE occurs more frequently, all deformity subclassifications occur more frequently in females, the majority present in adolescence, and all racial groups are affected. The right side predominated. This study suggests that simultaneous condylectomy and orthognathic surgery provides predictable and stable outcomes for patients with active unilateral condylar hyperplasia and associated dentofacial deformities with an improvement in quality of living.

Modified Cupar's method for immediate diastema closure

Anterior maxillary osteotomy or ostectomy (AMO) is a safe, reliable, and easily adaptable procedure routinely performed in orthognathic surgery for the management of the dentoalveolar segment of the anterior maxilla. The anterior segmental maxillary osteotomy was first performed in 1921 by Cohn-Stock. Several modifications were done regarding approaches for AMO; however, Cupar's method is the most preferred approach by the surgeons and in practice since several decades. A novel midline split osteotomy is performed in combination with Cupar's method for superior and posterior repositioning of anterior maxillary segment in combination with immediate closure of diastema in this case report.

Conformity of Virtual Surgical Plans to Postoperative Results in Segmental Orthognathic Surgery

Background/purposeVirtual surgical planning (VSP) in orthognathic surgery has enabled reconstructive surgeons to achieve more predictive results when compared to conventional methods. Still, few studies have evaluated the accuracy of VSP in more complex cases, such as those requiring maxillary segmentation. The aim of this study was to examine the conformity of virtual surgical plans to postoperative results following segmental procedures performed by a single surgeon. MethodsThis was a retrospective study of patients who had undergone triple jaw (segmental Le Fort I, bilateral sagittal split osteotomy, and genioplasty by the senior author (DMS) between 2016 and 2020. The preoperative virtual surgical plan and postoperative cone beam computed tomographic scan were registered in 3-Matic software (Materialise, Leuven, Belgium) using cranial base landmarks. The conformity of the postoperative skull model to the virtual surgical plan was quantified using linear and angular measurements at various 3D bony landmarks. The average mean difference (AMD) in the x-, y-, and z-axes was calculated. Paired T-tests were used to compare postoperative measurements with those from the pre-operative STL. Multivariate linear regression was performed to analyze and modifying effects of age, gender, number of segments (2 vs. 3), and malocclusion class. ResultsTwenty-nine patients were included (mean age 24.5 years; 72.4% female). Three-dimensional analysis showed significant AMD between the virtual plan and postop CBCT for the following landmarks: U1 Midpoint (y, AMD: 1.65mm, P = .03), B point (y, AMD: 1.63mm, P = .005), pogonion (y, AMD: 2.38mm, P = .0005), menton (y, AMD: 2.22mm, P = .0003). There were no differences between the virtual plans and postop CBCT at any other points. Transversely, the overall AMD was 1.15mm, with under-expansion occurring in 79.3% (2.18mm) and over-expansion in 20.7% of patients (1.65mm). Angular measurements revealed statistical significance for SNB (AMD: 1.38, P = .02), but not for SNA and ANB values. Multivariate regression showed no association between age, gender, segmentation (2 vs. 3), or class of malocclusion and the extent of conformity for any measurements. ConclusionThere is a high degree of conformity between the VSP and postoperative results following triple jaw orthognathic surgery with segmental maxillary osteotomies. The greatest nonconformity was found in the sagittal plane and was mostly limited to the mandible. Segmentation did not affect surgical accuracy of the maxillary movements.

Single-Sided Segmental Maxillary Osteotomies for Alveolar Cleft Deformities.

Although the use of a one-sided segmental maxillary osteotomy has been described for repairing alveolar clefts, there remains little consensus regarding the indications and outcomes of such approaches. This brief clinical note aims to summarize previous studies of one-sided segmental maxillary osteotomies for alveolar cleft (AC) repair. A literature search yielded only 2 articles that described the use of a single-sided segmental maxillary osteotomies (SMO) for AC repair. The overall outcomes for the implementation of SMO in correcting AC were positive without major or minor complications. Although the available studies show promising results for the single-sided SMO technique, further validation is warranted to assess the indications and outcomes for this technique.

Complications Following One-Stage Versus Two-Stage Surgical Treatment of Transverse Maxillary Hypoplasia

Contemporary literature suggests a similar transverse stability of a surgical-assisted rapid palatal expansion and a segmented Le Fort I osteotomy. The aim of this study was to compare postoperative complications of 1-stage (segmental maxillary osteotomy) and 2-stage (surgical-assisted rapid palatal expansion followed by Le Fort I osteotomy) treated patients to determine the preferred treatment strategy. This retrospective study included 74 consecutive patients (age range: 14 - 57years; 36 males, 38 females) with a moderate transverse maxillary hypoplasia: 32 patients were treated in a 1-stage protocol and 42 in a 2-stage protocol with a postoperative follow-up of at least 1year. Dental complications such as loss of teeth, gingival dehiscence, periodontal bone loss, apical root resorption, and surgical complications such as pain, hemorrhage, altered neurosensitivity, wound infection, aseptic necrosis were analyzed. Univariate analysis consisted of a generalized linear model with logit link or Fisher exact test. No significant difference was found for group characteristics except for longer orthodontic treatment time in the 2-stage group. Incidence and severity of complications were comparable for the 1-stage and 2-stage patients. Only overall pain was significantly greater in the 2-stage patient group (P=.038). Considering a similar complication rate and transversal stability, the choice between 1-stage and 2-stage approach for patients with a moderate transverse maxillary hypoplasia should be patient specific.

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

One-piece Lefort osteotomy versus segmental procedure for maxillary skeletal deformities - A retrospective study

Maxillary skeletal deformities can occur in all three planes and are corrected by orthognathic surgery. Osteotomies form the basis for orthognathic surgeries. One of the most commonly used osteotomy techniques for maxillary skeletal deformities is the LeFort osteotomy. The aim of this study was to compare the application of One Piece LeFort Osteotomy and Segmental Osteotomy procedures in the treatment of maxillary skeletal deformities. The institutional study involved analysis of case sheets of patients who underwent surgical correction of maxillary skeletal deformities in the stipulated time frame and assessment based on the parameters: Demographic data, type of cephalometric analysis, cephalometric values, type of skeletal deformity, and technique of Osteotomy. Statistical analysis was calculated by chi-square test. A p-value<0.05 was considered significant. Maxillary skeletal deformities were more prevalent among females (60%) than males (40%). Anterior maxillary segmental osteotomies were more commonly performed (60%), followed by LeFort 1 osteotomy (26.7%). The prevalence of posterior osteotomy technique was 13.3%. A statistically significant association was revealed between the type of skeletal malocclusion and technique of Osteotomy used, with a p-value of 0.008<0.05. The type of malocclusion dictates the technique of Osteotomy is used. In a skeletal Class II, segmental malocclusion procedure was more preferred for maxillary deformities.

Camouflage treatment of posterior bite collapse in a patient with skeletal asymmetry by using posterior maxillary segmental osteotomy

Orthodontic treatment of posterior bite collapse due to early loss of molars and the consequent drift of adjacent teeth is complicated. When the posterior bite collapse occurs in patients with facial asymmetry, both transverse and vertical compensation are necessary for camouflage orthodontic treatment. In such cases, posterior maxillary segmental osteotomy (PMSO) can be an effective alternative procedure that simplifies the orthodontic treatment and shows long-term stability through dental compensation within the alveolar bone housing. This case report aimed to describe the orthodontic treatment of maxillary occlusal plane canting caused by severely extruded maxillary teeth in a patient with skeletal facial asymmetry that was corrected with PMSO along with protraction of the lower second molar to replace the space of the extracted first molar. The treatment duration was 18 months, and stable results were obtained after 2 years of retention.

Evaluation of Tissue Tensions in Segmental Maxillary Osteotomies by Finite Element Analysis

Maxillary segmentation associated with Le Fort I osteotomy is a surgical technique used to correct transverse maxillary discrepancies. Notwithstanding advances over the years, there are still complications arising from this surgical intervention, including the maintenance of sufficient blood supply and excessive tension of the palatal fibromucosa. Therefore, the aim of this study was to analyze the effect of the force applied during surgery on bone dislocation and fibromucosa tension in different maxillary segmentation designs by finite element analysis. A 3-dimensional skull was generated from tomographic images. We worked with 4 models. In 2 models, we divided the maxilla into 3 segments: one with osteotomy between the lateral incisor and canine and the other between the canine and first premolar. In the other 2 models, we divided the maxilla into 4 segments with the same osteotomies previously mentioned. A force of 100N was applied to the palatal surfaces of the right and left permanent maxillary first molars. When comparing the technique between 3 and 4 segments with the same interdental osteotomy, we evidenced greater bone dislocation and less fibromucosa tension in the 3-segment technique. When we contrast the same number of segments with different regions of interdental osteotomy, we noticed a lower fibromucosa tension and a greater bone dislocation in the lateral incisors and canine. The technique with 3 segments and with interdental osteotomy between the lateral incisor and canine presented less resistance, allowing greater dislocation and consequently generating less mucosa tension.

Treatment of anterior open bite by posterior maxillary segmental osteotomy and miniplates: a case report

BackgroundAnterior open bite is a challenging malocclusion to correct orthodontic treatment. Anterior open bite associated with over-erupted posterior teeth and long lower facial height should be treated by reduction of posterior dimension for esthetic results. Although the possibility of orthodontic treatment of an anterior open bite has increased with the introduction of skeletal anchorage, there are still cases requiring surgery for various reasons.Case presentationThis case report covers an anterior open bite of a 25-year-old man successfully treated with the posterior maxillary segmental osteotomy (PMSO) and miniplates. After the pre-surgical orthodontic treatment, the PMSO between canines and first premolars was performed under local anesthesia and miniplates were placed on the zygomatic buttress. As a result of 28 months of treatment, an impaction amount of 3.5 mm was obtained in the maxillary posterior teeth, and the facial esthetics improved at rest and smile.ConclusionThe impaction of the posterior dentoalveolar segment using the PMSO can be a good treatment option in patients with anterior open bite showing long lower facial height.

Rotating a Segmental Maxilla to Close a Serious Vertically Displaced Alveolar Cleft

In recent years, alveolar bone grafting has emerged as the first treatment choice for space closure in the secondary dentition. Despite this, a high possibility of failure still exists for patients with a vertical discrepancy of cleft segments. This is attributed to the absence of valid contact between the grafted bone and the surfaces of bone segments in the cleft region. In cases of minor discrepancies, the vertical distance can be reduced orthodontically, allowing for subsequent alveolar bone grafting.1 However, in severe cases, isolated orthodontic treatment is not viable due to a high risk of periodontal problems and increased tooth mobility. Under the circumstances, surgical intervention is essential. Herein, we report a case in which the alveolar segment is aligned using a novel application of segmental maxillary osteotomy to rotate the segment with a subperiosteal tunnel. Rigid fixation of the segment in the desired position is then performed with concurrent bone grafting. Therefore, performing segmental maxillary osteotomy before bone grafting could be an alternative to correcting the vertical discrepancy encountered in cleft patients.