OMFS

1. z
ANTERIOR
SEGMENTAL
MAXILLARY
OSTEOTOMY
PRESENTED BY
DINESH VENKATESAN
FINAL YEAR BDS
MAXILLARY OSTEOTOMY

2. z
HISTORICAL EVIDENCE
 1921 – Cohn Stock performed first maxillary ostetomy
 Wedge shaped maxillary Osteotomy through transverse palatal
incisions
 Succeeded by green stick fracture of Anterior maxillary segment
that was retracted
 Relapsed in 4 weeks

3. z
INDICATIONS
 In Correction of Protrusion of Maxillary Anterior Teeth with
normal axial inclination with alveolar bone.
 In Correction of Anterior Open Bite provided absence of
maxillary excess.
 Vertical Plane Premaxilla correction – Openbite / Deep Bite.
 Failure in Orthodontic Therapy due to Ankylois or Pathological
Resortion of Maxillary Anterior Teeth.
 To improve Facial Appearance in prognathic maxilla with
competent lips and adequate lip length.

4. z
Techniques in AMO
 Wassmund Technique
 Wunderer Technique
 Cupar’s Technique

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WASSMUND TECHNIQUE
 Vertical Incision between Canine and Premolar extending to
nasal floor.
 Mucoperiosteum is reflected posteriorly.
 In apical region of canine, reflection is made till nasal pyriform
aperture.
 First Premolars are extracted (if planned) at this stage

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 Midline Sagittal Incision is made anteroposteriorly on palate to
perform palatal osteotomy.
 Palatal Mucosa is reflected and care is taken not to injure anterior
palatine vessels.

7. z
 Bony Cut is made on buccal aspect of alveolus.
 Cut is taken vertically upwards and turned medially to pyriform
aperture so that 3-5 mm of bone remains intact in canine apex.
 Transpalatal osteotomy of palatal bone from alveolus of one side
to other side.
 As advancing to midline osteotomy becomes hard dure to
thickness of bone and access difficulty which is overcome by
Midpalatine insidion made early.

8. z
 Maxillary segment is now separated from nasal septum by finger
pressure sometimes.
 Usually Vertical incision is placed over anterior nasal spine;
mucoperiosteum is reflected from nasal spine & cartilaginous
nasal septum.
 Nasal Osteotome is used to separate anterior maxillary segment
and nasal septum.
 Folds of soft tissue are checked for proper blood supply and
closed using catgut 3-0

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10. z
WUNDERER TECHNIQUE
 Used especially when second premolar is extracted
 Labial Approach is similar to Wassmund Technique.
 Palatal Surgery is started after Buccal part of Surgery.

11. z
 Here Transverse Palatal Cut anterior to planned osteotomy site.
 In midline bone is little harder but access is good and cut can
done as posterior as second premolar.
 Anterior Segment can be mobilized and separated from nasal
septum.
 It is then postioned & fixed using prefabricated occlusal splints.

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13. z
Cupar’s Technique
 Buccal Vestibular Incision is created.
 Nasal Mucosa is elevated from superior surface of maxilla.
 Vertical Osteotomy is done.
 Through this vertical cut, transpalatal osteotomy is completed
using osteotome or reciprocating saw.
 A finger is placed on palatal mucosa to palpate the osteotome to
prevent palatal tissue damage.

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16. z
AMO FIXATION
 OCCLUSAL STENT STABILIZATION
 OSSEOUS WIRING
 SKELETAL FIXATION
 REIGID INTERNAL FIXATION

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ADVANTAGES
 Direct access to nasal structures
 Preservation of blood supply through excellent palatal pedicle.
 Ability to remove palatal none directly after down fracture of
anterior maxilla.
 Excellent access to superior maxilla.
 Easy placement of rigid fixation.

18. z
COMPLICATIONS
 Loss of Vitality
 Damage to Tooth Roots
 Persistent Periodontal Problmes
 Osseous Necrosis of Dento-osseous segments
 Communication of nasal cavity and maxillary sinus
 Hemorrhage
 Oronasal or Oroantral Fistulas
 Atrophic Rhinitis
 Nasal Septal Deviation
 Unfavorable nasal esthetics

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