title: Facial morphology changes after total maxillary setback osteotomy.
abstract: OBJECTIVE
  To evaluate the morphologic outcome after total maxillary setback osteotomy (TMSO) in dentofacial Class II deformity patients with marked upper jaw prognathism.
  
  
  METHODS
  The assessments of 9 patients before and after TMSO were compared. The evaluation was based upon x-ray superimpositions and standardized photographic comparison. TMSO was performed through a conventional Le Fort I operation with resection of the inferior end of the pterygoid processes.
  
  
  RESULTS
  All patients presented with marked upper jaw prognathism initially and have had a bimaxillary surgery with a mean maxillary setback of 3.1 mm. All patients ended in Class I occlusion after at least 1-year of follow-up. An opening of the nasolabial angle (mean 8.9 degrees) was noted for all but 2 patients. At the same time, the suborbital profile was nicely modified as a result of substantial heightening of the prezygomatic soft tissues in all patients, even without vertical maxillary intrusion.
  
  
  CONCLUSIONS
  These results challenge the notion of unavoidable facial alteration commonly associated with upper setbacks. TMSO allows combining satisfactory functional and cosmetic results for a number of carefully selected patients. Pronounced maxillary protrusion with acute nasolabial angle is a prerequisite. The release of the deforming strains of the dysmorphosis upon the midface will improve the suborbital profile. Bimaxillary surgery is recommended to leverage the setback and the opening of the naso-labial angle.
authors.affiliation: Pitié-Salpetriere University Hospital, Department of Oral and Maxillofacial Surgery, University of Paris 6, Pierre et Marie Curie, Paris, France. thomas.schouman@psl.aphp.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Schouman
authors.forename: Marie-Madeleine
authors.initials: MM
authors.lastname: Baralle
authors.forename: Joël
authors.initials: J
authors.lastname: Ferri
mesh_terms: D000293:Adolescent; D000328:Adult; D002508:Cephalometry; D005145:Face / Q000033:anatomy & histology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008312:Malocclusion, Angle Class II / Q000150:complications / Q000601:surgery*; D008437:Maxilla / Q000002:abnormalities / Q000601:surgery*; D008445:Maxillofacial Development; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D011378:Prognathism / Q000150:complications / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult