Orthognathic surgery maxillary deformities , maxillary repositioning procedures and complications

Presented by : Dr. Shweta Moderator : Dr. Anuradha Navaneetham

Maxillary deformities

Vertical Transverse Anteroposterior

Facial disproportion
Symmetrical disproportion
maxillary enlargement maxillary deficiency

Asymmetrical disproportion

Maxillary enlargement
Dentoalveolar protrusion Panmaxillary enlargement Vertical maxillary excess

Maxillary deficiency
Supra-apical maxillary hypoplasia Vertical maxillary deficiency Nasomaxillary hypoplasia Lateral maxillary deficiency Total midface hypoplasia Crouzens syndrome Aperts syndrome

Middle face assymetries

Cleft lip and cleft palate syndrome Localized maxillary pathology Secondary maxillary assymetries Hemifacial atrophy Hemifacial hypoplasia Hemifacial hypertrophy

Dentoalveolar protrusion

Panmaxillary enlargement

Vertical maxillary excess

Vertical maxillary excess

long lower facial height lip incompetence excessive incisor display at rest excessive gingival display on smile

Vertical maxillary deficiencies

Short lower facial third Diminished maxillary incisor display at rest Diminished incisor display on smile

Supra-apical maxillary hypoplasia

Nasomaxillary hypoplasia group 1

Nasomaxillary hypoplasia group 2

Nasomaxillary hypoplasia group 3

Nasomaxillary hypoplasia group 4

Lateral maxillary deficiency

Total mid face hypoplasia

Post trumatic cleft

Mid third assymetries

Special groups

History
1859 1867 1901 1927 1934 1942 1949 1965 Von Langenbeck Cheever Le Fort Wassmund Axhausen Schuchardt Moore and Ward Obwegeser

Surgical options
Total maxillary osteotomies Segmental alveolar maxillary osteotomies

Total maxillary osteotomies

Lefort I Lefort II Lefort III

Segmental alveolar maxillary osteotomies

Anterior maxillary osteotomies Posterior maxillary osteotomies Combined procedures

Superior repositioning Inferior repositioning Anterior repositioning Posterior repositioning

Surgical technique
Surgical exposure, osteotomy cuts, pterygomaxillary dysjunction Mobilization & advancement Fixation Bone grafting

Lefort I osteotomy

Indications
Low mid face hypoplasia Maxillary hyperplasia Cant in occlusion Cleft patients Open bite

Soft tissue changes

Exposure

Maxillary mobilization
Stage I Stage II Stage III

Practical points

Lefort I osteotomy
Variation I : with midline narrowing Variation II : with midline widening Variation III : with superior repositioning Variation IV : with inferior repositioning

Lefort II osteotomy

Indications
Nasomaxillary hypoplasia
Group Group Group Group I II III IV

Profile changes

Exposure

Practical points

Lefort II osteotomy
Variation I : with inferior repositioning Variation II : with naso-orbital maxillary advancement of converse Variation III : kufners modification Variation IV : with lateral extensions

Le fort II variation 2

Lefort II variation 3

Le fort III osteotomy

Lefort III osteotomy

Variation I : with inferior repositioning Variation II : with transverse frontal crescent Variation III : lefort III + I

Anterior segmentl osteo.

Corticotomy with interradicular osteotomy Anterior maxillary osteotomy wassumand method wundrers method cupars method

Posterior segment osteotomies

Kufner

Perko Bell approch

Thank you