Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

6 maxillary osteotomies

11,572 views

Published on

6 maxillary osteotomies

  1. 1. Maxillary osteotomies Dr V.RAMKUMAR CONSULTANT DENTAL&FACIOMAXILLARY SURGEON REG NO:4118-TAMILNADU-INDIA(ASIA)
  2. 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. 3. Patient evaluation and diagnosis 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
  4. 4. Orthognathic planning To get 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
  5. 5. Cont’d 5.Radiographic analysis a. Cephalometric b. Orthopantomogram 6.Dental study models 7.Speech 8.Audiometry 9.Medical and psychological
  6. 6. Sequence of treatment planning Dental and periodontal Extractions Presurgical orthodontics Orthognathic surgery Post surgical orthodontics Maintenance Others
  7. 7. Presurgical orthodontics Position the 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
  8. 8. Types Segmental maxillary surgery 1. Single tooth osteotomy 2. Corticotomy 3. Anterior segmental osteotomy a.wassmund-1935 b.wunderer-1963 c. Cupar’s down fracture
  9. 9. Cont’d 4.Posterior segmental osteotomy Schuchardt Kufner Perko & Bell 5.Horse shoe osteotomy Wolford and epker
  10. 10. 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
  11. 11. Cont’d Le fort III osteotomy Gillies Tessier 4.Other midface osteotomies a. Zygomatic osteotomies b. Malar –maxillary osteotomy
  12. 12. 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
  13. 13. 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
  14. 14. Corticotomy To permit surgically 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
  15. 15. Posterior segmental maxillary osteotomy Correction of anterior or posterior open bite Correction of posterior cross bites Closure of edentulous spaces as in cleft cases
  16. 16. 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
  17. 17. 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
  18. 18. Cupar’s down fracture Pre operative Post operative
  19. 19. technique Incision Osteotomy cuts
  20. 20. Cont…. Fixation – wire osteosynthesis Closure
  21. 21. Wassmund technique Incisions vertical incisions in premolar region and along frenum Midline sagittal section along hard palate
  22. 22. osteotomies bone cuts made 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
  23. 23. Wunderer technique Similar to wassmund Palate is exposed by a transverse palatal incision with margins away from osteotomy site
  24. 24. Le fort I osteotomy 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
  25. 25. incision Osteotomy cuts Pterygoid dysjunction
  26. 26. Surgical technique Vestibular incision 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
  27. 27. Cont’d Osteotomy of lateral nasal wall and septum Separation of pterygomaxillary junction Curved osteotomes used for pterygoid disjunction Down fracture of maxilla using rowes disimpaction forceps
  28. 28. Cont’d Complete mobilization and trimming of maxilla is done Maxilla should be able to sit in a passive position Stability and healing is facilitated by interpositional bone grafts
  29. 29. Case -1 Incision Osteotomy cuts
  30. 30. Cont….. Completion of osteotomy cuts Down fracture
  31. 31. Cont… Pre op Cephelogram Post op Cephelogram
  32. 32. Le fort II osteotomy For correction of nasomaxillary hypoplasia It is a pyramidal naso-orbital maxillary osteotomy
  33. 33. Le fort III osteotomy Total midface osteotomy For correction of various craniofacial syndromes like aperts crouzon etc
  34. 34. Post surgical orthodontics Final tooth alignment and parallelism Maximum inter digitations Ideal overbite and over jet Centric occlusion =centric relation
  35. 35. THANK YOU

×