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6 maxillary osteotomies
- 1. Maxillary osteotomies DrV.RAMKUMAR CONSULTANT DENTAL&FACIOMAXILLARY SURGEON REG NO:4118-TAMILNADU-INDIA(ASIA)
- 2. Common maxillary deformities Maxillary anteroposterior excess Maxillary anteroposterior deficiency Vertical maxillary excess Vertical maxillary deficiency Alveolar clefts Craniosynostoses (aperts,crouzon) Binders syndrome achondroplasia
- 3. Patient evaluation anddiagnosis a. Patient concerns b. Clinical evaluation 1. Facial form-frontal and profile long, short, convex, concave, flat 2. Relation ship of facial thirds 3. Soft tissue –dentition relations smile line, Occlusal cant, dental midlines
- 5. Orthognathic planning Toget an optimal balance between 1.Aesthetics 2.Function 3.Stability 4.Clinical measurements a. Vertical dimensions b. Antero posterior dimensions c. Transverse dimensions d. Intra arch dimensions
- 6. Cont’d 5.Radiographic analysis a. Cephalometric b. Orthopantomogram 6.Dental study models 7.Speech 8.Audiometry 9.Medical and psychological
- 10. Sequence of treatmentplanning Dental and periodontal Extractions Presurgical orthodontics Orthognathic surgery Post surgical orthodontics Maintenance Others
- 11. Presurgical orthodontics Positionthe teeth over their respective basal bone Align and level the teeth Adjust for tooth size discrepancies Correct rotated teeth Co-ordinate upper and lower arch widths
- 12. Types Segmental maxillarysurgery 1. Single tooth osteotomy 2. Corticotomy 3. Anterior segmental osteotomy a.wassmund-1935 b.wunderer-1963 c. Cupar’s down fracture
- 13. Cont’d 4.Posterior segmentalosteotomy Schuchardt Kufner Perko & Bell 5.Horse shoe osteotomy Wolford and epker
- 14. Total maxillary surgery Le fort I osteotomy a. Classic down fracture b. Buttress release (surgically assisted maxillary expansion) c. Quadrangular Le fort II osteotomy a. Anterior b. Pyramidal c. quadrangular
- 15. Cont’d Le fortIII osteotomy Gillies Tessier 4.Other midface osteotomies a. Zygomatic osteotomies b. Malar –maxillary osteotomy
- 19. Segmental maxillary osteotomies Surgical repositioning is possible for small dento alveolar segments provided maximum mucoperiosteal attachment is maintained Incisions planned such that maximum soft tissue pedicle is maintained Apicoectomy of teeth should be avoided during the procedure to prevent pulpal atrophy
- 20. Single tooth osteotomies for upper anterior teeth which are dilacerated or traumatically impacted Incision-high vestibular cut or two vertical incisions on either side of tooth Osteotomy- 3 mm apical to root apex and at least 2-3 mm from alveolar crest Separation done using fine osteotomes Fixing done to adjacent teeth using inter dental wires
- 21. Corticotomy To permitsurgically assisted retraction of upper anterior teeth in class II div I mal occlusions Vestibular incision from premolar to premolar is used Cortical bone removed labially and palatally Bone also removed from 5mm above the teeth
- 22. Posterior segmental maxillary osteotomy Correction of anterior or posterior open bite Correction of posterior cross bites Closure of edentulous spaces as in cleft cases
- 23. Horse shoe osteotomy Palate remains in original position Dento alveolar complex alone is repositioned Aim is to minimize the size of the reduction of the nasal cavity Technically difficult since multiple areas of bony contacts are there
- 24. Anterior segmental maxillary osteotomy Used when alteration of premaxilla in the vertical plane is required as in anterior open bite or deep over bite Three techniques are usually described Down fracture technique preferred when vertical movement is required
- 25. Cupar’s down fracture Pre operative Post operative
- 26.
- 27. Cont…. Fixation –wire osteosynthesis Closure
- 28. Wassmund technique Incisions vertical incisions in premolar region and along frenum Midline sagittal section along hard palate
- 30. osteotomies bone cutsmade through tunneling approach under mucosa Buccal- right angled osteotomy with extraction of first premolars Sub labial-separation of nasal septum and lateral nasal wall Palatal-transverse cut from first premolar to first premolar 10-15 mm of bone between nasal floor and tooth apices
- 31. Wunderer technique Similarto wassmund Palate is exposed by a transverse palatal incision with margins away from osteotomy site
- 35. Le fort Iosteotomy Classic le fort I down fracture (bell) 1.Allows full mobilization of maxilla 2.Permits bone surgery under direct vision 3.Reduced risk of relapse
- 36. incision Osteotomy cuts Pterygoid dysjunction
- 37. Surgical technique Vestibularincision from first molar to first molar Osteotomy at least 5 mm above apices of the teeth Anterior cut-4-5 mm above canine vertical cut-zygomatic buttress region Posterior cuts-4-5 mm above molar apices
- 38. Cont’d Osteotomy oflateral nasal wall and septum Separation of pterygomaxillary junction Curved osteotomes used for pterygoid disjunction Down fracture of maxilla using rowes disimpaction forceps
- 39. Cont’d Complete mobilizationand trimming of maxilla is done Maxilla should be able to sit in a passive position Stability and healing is facilitated by interpositional bone grafts
- 40. Case -1 IncisionOsteotomy cuts
- 41. Cont….. Completion ofosteotomy cuts Down fracture
- 42. Cont… Pre opCephelogram Post op Cephelogram
- 43. Le fort IIosteotomy For correction of nasomaxillary hypoplasia It is a pyramidal naso-orbital maxillary osteotomy
- 46. Le fort IIIosteotomy Total midface osteotomy For correction of various craniofacial syndromes like aperts crouzon etc
- 48. Post surgical orthodontics Final tooth alignment and parallelism Maximum inter digitations Ideal overbite and over jet Centric occlusion =centric relation
- 53.