Superior Repositioning Of Maxilla Research Articles

Influence of the Inferior Turbinate on the Accuracy of Superior Maxillary Repositioning.

Notably, many studies have focused on the bony interference in the maxillary segment when performing maxillary superior repositioning; however, few reports have described the interference with the inferior nasal turbinate. Therefore, the authors aimed to retrospectively analyze the soft tissue or bone tissue volume of the inferior nasal turbinate and the accuracy of maxillary superior repositioning in Le Fort I osteotomy (LF1). The authors included 83 patients with facial deformities who underwent conventional LF1 (maxillary molar elevation between 4.0 and 6.0mm) with/without bilateral sagittal split ramus osteotomy. The ratio of the soft tissue of the inferior turbinate to that of the inferior nasal cavity was used to divide the participants into 2 subgroups (large and small ratio). Similarly, the bony tissue volume of the inferior turbinate was used to divide the participants into 2 subgroups (large and small bony tissues), and the planned or actual amount of superior repositioning was compared 3 dimensionally. In the soft tissue group, the subgroups showed no significant differences (P=0.934). However, the actual maxillary superior repositioning was significantly lower in the large bone group than in the planned maxillary elevation group (P<0.01). In cases where the maxillary molar needs to be elevated by >4mm and the bone tissue of the inferior nasal turbinate is well developed, an adjunctive technique such as horseshoe osteotomy or partial inferior turbinate resection should be considered in addition to LF1 to avoid interference between the inferior nasal turbinate and the maxillary bone fragments.

Comparison of skeletal stability with rigid and wire fixation in patients who have undergone Le Fort I and Anterior Segmental Maxillary Osteotomy

ABSTRACT Background: Maxillary superior repositioning is widely regarded as the most stable procedure in orthognathic surgery, requiring minimal instruments for stabilization. Rigid fixation is considered the ideal method for long-term stability, leading to improved anatomic structures, enhanced recovery of bite forces, and better bite function. Objective: To compare the skeletal stability following Le Fort I and anterior maxillary osteotomy with wire osteosynthesis and rigid fixation. Materials and Methods: A total of 16 patients, including one male and 15 females, underwent Le Fort I and anterior segmental maxillary osteotomy along with fixation using either wire osteosynthesis or rigid fixation for correction of vertical and anteroposterior maxillary excess. Patients were assessed at preoperative, 1-week postoperative, and 6-month postoperative stages using a lateral cephalogram to evaluate skeletal stability. Results: The wire osteosynthesis group showed significant differences in posterior maxillary vertical measurements compared to the rigid fixation group. However, there was no significant difference in anterior vertical and anteroposterior skeletal measurements between the two groups. Conclusion: Wire osteosynthesis is a stable form of fixation for superior repositioning with segmentation of the maxilla for correction of vertical and antero-posterior excess.

Craniofacial Manifestation and Orthosurgical Management of a Patient with Achondroplasia

Achondroplasia is a bone growth disorder results due to failure in endochondral ossification, conversion of cartilages into mature bones. It is the most common metaphyseal dysplastic condition of long bones. The incidence of achondroplasia is 1:25000–30,000 of live births. Our patient was a diagnosed case of achondroplasia, characterized by short stature, disproportionately short arms and legs, and short fingers. Craniofacial features include prominent forehead (frontal bossing), short cranial base, short nose, depressed nasal bridge, short upper lip leading to increased incisal show along with gingival visibility and hyperactive mentalis. Intraoral examination revealed constricted maxillary arch, multiple missing teeth, increased overjet of 12 mm, nonspecific molar, and canine relation bilaterally. Therapeutic intervention included orthosurgical management, i.e., Stage I (presurgical orthodontics)-leveling and alignment followed by closure of extraction spaces; Stage II (surgical management)–le fort-1 osteotomy and maxillary superior repositioning of 6 mm followed by 5 mm bilateral sagittal split ramus osteotomy with anticlockwise rotation of body of the mandible; and Stage III–settling of occlusion and fixed retention in maxillary and mandibular arch. Present case highlights the craniofacial manifestations of achondroplasia its effective management and the potential complications associated. Treating orthodontist should be aware of these features and their consequences in managing the patient to achieve a successful outcome.

Does maxillomandibular fixation affect skeletal stability following mandibular advancement? A single-blind clinical trial.

BackgroundThe stability of the results remains a significant concern in orthognathic surgeries. This study aimed to assess the amount of relapse following mandibular advancement with/without maxillomandibular fixation (MMF).Materials and methodsA single-blind clinical trial was conducted on patients with mandibular retrognathism who underwent BSSO for mandibular advancement and Lefort I maxillary superior repositioning. Patients were randomly divided into two groups of treatment (MMF) and control (no MMF). In the treatment group, MMF was performed for 2 weeks; meanwhile, MMF was not performed in the control group, and only guiding elastics were applied postoperatively. Lateral cephalograms were obtained preoperatively (T1), immediately after surgery (T2), and at 1 year postoperatively (T3). The distance from points A and B to the X and Y plane were measured to identify the amount of vertical and horizontal relapse in 1 year as a primary outcome. An independent t-test was applied in order to find differences in outcomes between the control and treatment groups.ResultsFifty-eight patients were evaluated in two groups (28 patients in the MMF group and 30 in the no-MMF group). The magnitude of mandibular advancement following BSSO was 7.68±1.39 mm and 7.53±1.28, respectively, without significant difference among the groups (p= 0.68). The mean sagittal and vertical changes (relapse) at point B were significantly different between the two groups at 1-year follow-up after the osteotomy (p=0.001 and p=0.05, respectively).ConclusionAccording to the results of this study, patients with short-term MMF following BSSO for mandibular advancement benefit from significantly greater skeletal stability in the sagittal and vertical dimensions.

Does maxillary superior repositioning affect nasal airway function?

This study aimed to assess nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity in patients who have had maxillary superior repositioning (MSR). This is a cross-sectional study, and nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity were evaluated by rhinometry and acoustic rhinometry techniques in patients who had had MSR. Thirty-two patients were studied, and the mean (SD) MSR was 5.03 (1.61) (range 3-8) mm. There was a significant correlation between the mean MSR and the mean change in nasal airflow and nasal resistance (p=0.001 and p=0.005, respectively). There was also a correlation between MSR and the change in the cross-sectional area of the inferior concha (p=0.001), but there was no correlation between the mean MSR and the change in cross-sectional area of the isthmus (p=0.07). Nasal airflow increases when the mean MSR is less than 6.5mm, and when maxillary impaction is 6.5mm or more, nasal airflow decreases. It seems, therefore, that MSR of less than 6.5mm was associated with an improvement in nasal airflow. When maxillary impaction was more than 6.5mm, nasal airflow and the cross-sectional area of the nasal cavity decreased, and nasal resistance increased.

Stability of Vertical, Horizontal and Angular Parameters Following Superior Repositioning of Maxilla by Le Fort I Osteotomy: A Cephalometric Study.

The restoration of normal jaw function, optimal facial aesthetics and long term stability are the goals of any orthognathic surgical procedures. During the last two decades, several cephalometric investigations have been reported on the skeletal changes following maxillary surgical procedures. The stability following LeFort I osteotomy and maxillary superior repositioning of the maxilla has not been studied extensively. This study was aimed at determining the surgical changes brought about by superior repositioning of the maxilla by Le Fort I osteotomy and evaluate the stability of the surgical procedure one year following surgery. Presurgical and postsurgical and one year post surgical lateral cephalograms of 10 adult patients (age group - 17 to 40 years, with a mean age of 22.2 years) who had been treated successfully by maxillary Le-Fort I osteotomy and impaction were obtained. The lateral cephalograms were grouped into three categories: T1- Presurgical, T2- Postsurgical, T3- One year postsurgical. Comparisons were made between T1-T2 and T2-T3 to assess the changes following surgery and to evaluate the stability, one year following the surgery using 5 horizontal, 5 vertical linear and 2 angular measurement. Statistical analysis was done with SPSS (Version 17). Results were expressed as mean±standard deviation. A paired t-test was used to analyze the paired observations. The difference between T1 and T2 values of vertical changes showed that they were statistically highly significant whereas from T2 to T3 they were insignificant. The difference between T1 and T2 values of all the horizontal changes showed that they were statistically significant whereas True Vertical Line (TVL) to point Anterior Nasal Spine (ANS) was not statistically significant. The horizontal changes from T2 to T3 were statistically not significant whereas TVL to point Incisal edge of upper incisor (Is) was statistically significant. The angular changes from T1 to T2, T2 to T3 were statistically not significant. There was a significant reduction in the facial height and significant anterior movement of maxilla after surgery. Even after one year of surgery, negligible amount of relapse was recorded except at the incisors.

Correction of gummy smile by superior repositioning of maxilla in Bangladeshi people

Vertical maxillary excess is associated with gummy smile, incompetent lip, bimaxillary proclination, Angle’s class-I or class-II malocclusion with or without retogenia. After proper evaluation preoperative orthodontic treatment was performed in every cases and superior repositioning of the maxilla by Le Fort-I osteotomy is presented. Three patients with maxillary excess associated with retrogenia or microgenia were treated with this technique in combination with genioplasty. The maxillary segment was repositioned a maximum of 7.0 mm superiorly at point A. The mandible autorotated anterosuperiorly to achieve sound occlusion. Point B moved 1.0–3.0 mm anteriorly and 5.0–8.0 mm superiorly. The pogonion moved 4.0 mm anteriorly in a case done without genioplasty and the pogonion moved maximum 8.0mm in case done in combination with genioplasty. All patients obtained sound occlusion and a good profile after the operation. Almost no skeletal relapse was observed during 3 years of postoperative follow-up. Amount of gingiva showing during smile was ranges from 5.0mm –7.0mm which was 0-2.0mm after superior repositioning of the maxilla.&#x0D; Ban J Orthod &amp; Dentofac Orthop, April 2016; Vol-6 (1-2), P.1-5

Outfracture of the inferior turbinates during superior repositioning Le Fort I osteotomy with cone-beam computed tomographic analysis of the volume of the nasal cavity

We have investigated the volumes of the nasal cavities of 35 patients treated with superior repositioning Le Fort I osteotomy by analysing cone-beam computed tomography (CT) data with a 3-dimensional reconstruction program to correlate changes in the volume of the nasal cavity that were associated with the maxillary superior repositioning and the role of outfracture of the inferior turbinates. The patients were treated at the Pusan National Dental Hospital during the 14-month period January 2011-March 2012.. The patients were divided into two groups, the first of which consisted of 20 patients who had superior repositioning of 4mm or more with a mean superior movement of 5.2mm and outfracture of the inferior turbinates (outfracture group). The second group consisted of 15 patients who also had more than 4mm impaction with a mean superior movement of 5.0mm and for whom outfracture was not done (no outfracture group). Nasal symptoms were investigated preoperatively and 6 months postoperatively using the Nasal Obstruction Symptom Evaluation (NOSE) scale, and 3-dimensional volumetric analysis was made using cone-beam CT data to assess changes in nasal volume. There were significant differences between the groups in volumetric changes (V1-V2) (p=0.001) but no significant differences between the sexes. The volume of the nasal cavity in the outfracture group decreased by 20% after superior repositioning, but that in the no outfracture group decreased by 33%. Among the 20 patients in the outfracture group not one complained of nasal symptoms postoperatively. We conclude that outfracture of the inferior turbinates should be considered when the amount of superior movement of maxilla is more than 4mm.

Spatial changes of the chin in the vertical and sagittal planes after superior repositioning of the maxilla.

The mandible autorotates after maxillary superior repositioning. The aim of this study was to address the changes in chin position in the vertical and sagittal planes after maxillary superior repositioning. This cross-sectional study assessed participants who had class I occlusion with vertical maxillary excess and underwent maxillary superior repositioning. Two lateral cephalograms were taken in central occlusion and natural head position. The amount of maxillary superior repositioning was documented for every participant according to lateral cephalometric indices. The distance between the most prominent point of the chin and a perpendicular line from N to the Frankfort line was used to determine the sagittal changes of the chin before and after surgery. The distance from the N point to Me was used to assess the vertical changes of the chin before and after operation. The Pearson correlation test was used to determine the correlation between the amount of maxillary superior repositioning and the vertical and horizontal changes of the chin. The linear regression model was applied to predict the changes of the chin (dependent factor) according to the vertical change of the maxilla (predictive factor). The occlusal plane angle change, mandibular length, and mandibular plane angle were considered as variable factors. Twenty participants were studied. Analysis of the data demonstrated a significant correlation between the maxillary superior repositioning (predictive factor) and the horizontal and vertical changes of the chin. For every 1 mm of vertical change in the maxilla, the chin could be expected to move 0.21 mm horizontally. For a standard deviation increase of 1 in the maxillary position, the chin advanced by 0.753 of the standard deviation (β = 0.753). For every 1-mm change of the maxilla vertically, it could be estimated that the chin moved 0.71 mm vertically when the amount of maxillary impaction was 8 mm or less. For an increase in standard deviation of 1 in the position of the maxilla, the chin moved superiorly by 0.711 of a standard deviation (β = 0.711). In maxillary superior repositioning greater than 8 mm, for every 1 mm of superior repositioning, the chin moved 0.44 mm superiorly. There was a positive correlation between the occlusal plane change, mandibular length, mandibular plane angle as well as the vertical and horizontal changes of the pogonion (P = 0.001). The chin position after maxillary superior repositioning can be predicted according to the amount of maxillary vertical changes. The vertical change of the chin is more predictable than the horizontal change.

Role of Le Fort I Osteotomy in Orthosurgical Management of Maxillary Deformities in North Indian Population

Background : Le Fort I osteotomy is one of the most commonly performed procedure, either alone or in conjunction with other orthognathic procedures for maxillary deformities. Objective: The present prospective study pertains to definite diagnosis, orthosurgical planning with cephalometric predictions of dento-osseus deformities of maxilla and their correction by LeFort I osteotomy. Material and Methods: Fourteen patients with skeletal deformity along with malocclusion which was too severe to be corrected orthodontically alone were selected. Parameters were selected on the basis of clinical findings, cephalometrically hard and soft tissue landmarks [COGS (Burstone and Legan) and Steiners analysis]. Parameters were observed and compared preoperatively prediction values, postoperatively and on follow-up. Results: There were obvious improvement in various linear and angular readings of hard and soft tissues.In linear measurements,NANS ⊥ HP decreased from 57.62 ± 3.3 to 52.4 ± 2.9; ANS-Gn ⊥ HP decreased from 75.8 ± 8.1 to 69.3 ± 6.1; NA || HP reduced by approximately 5mm; N-Pg || HP decreased from -12.07 ± 9.6 to -3.78 ± 8.8 and PNS-N ⊥ HP decreased from 55.28 ± 5.08 to 58.07 ± 4.4. On analysis of angular hard tissue measurements, N-A-Pg angle decreased from 5.14 ± 5.75 to 4.17 ± 2.73 (superior repositioning of maxilla) and increased from 3.0 ± 1.4 to 4.5 ± 0.7 (inferior repositioning of maxilla);MP-HP angle, Ar-Go-Gn angle decreased following superior repositioning and increased following inferior repositioning of maxilla and SNA angle decreased from mean 80.8 to 79.5. Conclusion: LeFort I osteotomy is really a workhouse of orthognathic surgery in which maxilla can be mobilized in vertical and saggital planes to correct various dento-osseous deformities.

Surgical correction of class II skeletal malocclusion in an adult patient

Correction of skeletal deformities in adult patients with orthodontics is limited. Orthognathic surgery is the best option for cases when camouflage treatment is questionable and growth modulation is not possible. This case report illustrates the benefit of the team approach in correcting vertical maxillary excess along with class II skeletal deformity. A cosmetic correction was achieved by superior repositioning of maxilla with LeFort I osteotomy and augmentation genioplasty, along with orthodontic treatment. The patient's facial appearance was markedly improved along with functional and stable occlusion

Efficacy of v-y closure of upper lip after le fort I osteotomy advancement and superior repositioning on facial esthetics in comparison to simple continuous closure: a statistical analysis.

This study aims to evaluate efficacy of V-Y closure of upper lip incision on facial esthetics in comparison to simple continuous closure after Le Fort I advancement and superior repositioning of maxilla. Thirty-four patients were divided in two groups i.e. V-Y closure group (group I=17patients) and simple continuous closure group (group II=17patients). The preoperative and 1year post-operative linear and angular changes of hard and soft tissue points of groups I and II were statistically compared. Labial changes were more favourable in V-Y closure group in comparison to simple continuous closure group in both the Le Fort I maxillary movements. The upturning and forward movement of the nose were seen in both the maxillary movements but these nasal changes did not differ significantly between the groups. It was observed that the technique of V-Y closure of upper lip delivers adequate results contributing to better facial esthetics when compared to simple continuous closure.

An accurate maxillary superior repositioning technique without intraoperative measurement in bimaxillary orthognathic surgery

This article describes a simple and accurate technique for maxillary superior repositioning without any intraoperative measurement using reference points that can be the source of error in bimaxillary orthognathic surgery. A bilateral straight locking miniplates (SLMs)/screw system secured to the maxilla and mandible maintains the three-dimensional relationship between the mandible and the skull base precisely like the incisor pin of an articulator in model surgery. The maxilla can then be accurately moved into the planned position identical to that in model surgery by the SLMs technique.

Long-term stability of anterior open bite closure corrected by surgical-orthodontic treatment

In adults, superior repositioning of posterior maxilla with or without mandibular surgery has become the treatment method of choice to close anterior open bite. Study aim was to examine the long-term stability of anterior open bite closure by superior repositioning of maxilla or by combining maxillary impaction with mandibular surgery. The sample comprised 24 patients who underwent anterior open bite closure by superior repositioning of maxilla (maxillary group, n = 12, mean age 29.3 years) or by maxillary impaction and mandibular osteotomy (bimaxillary group, n = 12, mean age 30.8 years). Lateral cephalograms were studied prior to surgery (T1), the first post-operative day (T2) and in the long term (T3, maxillary group mean 3.5 years; bimaxillary group mean 2.0 years). Paired and two-sample t-tests were used to assess differences within and between the groups. The vertical incisal bite relations were -2.6 and -2.2 mm at T1; 1.23 and 0.98 mm at T2; and 1.85 and 0.73 mm at T3 in the maxillary and bimaxillary groups. At T3, all subjects had positive overbite in the maxillary group, but open bite recurred in three subjects with bimaxillary surgery. For both groups, the maxilla relapsed vertically. Significant changes in sagittal and vertical positions of the mandible occurred in both groups. In the bimaxillary group, the changes were larger and statistically significant. In general, the maxilla seems to relapse moderately vertically and the mandible both vertically and sagittally, particularly when both jaws were operated on. Overbite seems to be more stable when only the maxilla has been operated on.

Maxillary stability of combined maxillary superior repositioning and mandibular advancement using rigid fixation

Maxillary stability of combined maxillary superior repositioning and mandibular advancement using rigid fixation

Long-term soft tissue response to LeFort I maxillary superior repositioning.

The purpose of this study was to compare short-term (approximately 12 months postoperatively) and long-term (24 to 81 months postoperatively) records of 36 patients who underwent superior repositioning of the maxilla via LeFort 1 osteotomies. The parameters of measurement were set up to analyze the net response of the soft tissues of the face to superior repositioning of the maxilla. The results of this study show that soft-tissue changes associated with maxillary impaction are minimal and that no significant differences exist between twelve-month records and five-year records.

Three-dimensional changes of upper lip and nose following maxillary superior repositioning

Three-dimensional changes of upper lip and nose following maxillary superior repositioning