Subapical anterior maxillary segmental osteotomy: a modified surgical approach to treat maxillary protrusion.
BACKGROUND
Anterior segmental osteotomy has become an established surgical technique to achieve functional occlusion and improve the facial profile in the treatment of maxillary protrusion. Postoperative nasal changes, however, are somewhat unpredictable. The here presented subapical anterior maxillary segmental osteotomy has been developed to avoid such unintended nasal changes.


METHODS
Thirty-two patients (29 women and 3 men; age range, 18-40 y; mean age, 22 y) with maxillary protrusion underwent subapical anterior maxillary segmental osteotomy. A horizontal osteotomy was carried out between the apices of the anterior teeth and the piriform aperture, maintaining a distance of approximately 2 to 3 mm to the apices. Lateral to both canines, this horizontal osteotomy was connected with vertical osteotomies carried out along the alveolar socket of the first premolar on the right and left sides. Lateral cephalograms and lateral and en face photographs were taken preoperatively and postoperatively for analysis. All patients were followed up for at least 6 months.


RESULTS
Significant changes were observed in hard tissue parameters except the anterior nasal spine. The nasal tip, the alar base, and the lip width remain to have no significant change. The ratio of the upper lip to the maxillary incisor retraction was 0.64:1. Whereas both the nasolabial angle and the philtrum length were significantly increased, the protrusion of the upper incisors and the vermilion length presented decreased. The intraoperative and postoperative courses were uneventful during the entire follow-up period.


CONCLUSIONS
Subapical anterior maxillary segmental osteotomy provides a suitable option in the treatment of maxillary protrusion. It provides improvement of the aesthetic profile without nasal changes.
Wu
Zhong Xing
ZX
Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Key Laboratory for Oral Biomedical Engineering of the Ministry of Education, Wuhan University, Wuhan, People's Republic of China. wzx789@hotmail.com
Zheng
Li Wu
LW
Li
Zu Bing
ZB
Ye Weng
San Jie
SJ
Yang
Xue Wen
XW
Dong
Yao Jun
YJ
Zwahlen
Roger A
RA
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000601:surgery*; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome