Alar base widening and nasal tip upward movement are undesirable soft tissue changes taken place after maxillary orthognathic surgery. With the use of piezoelectric device (PED), maxillary anterior alveolar osteotomy and Le Fort I type osteotomy are performed without making horizontal vestibular mucosal incision to preserve the soft tissue shape.

Methods: For anterior alveolar osteotomy, a pair of 3-cm mucoperiosteal incision is made from the premolar area in a slightly posterosuperior direction. Any premolar teeth to be extracted are extracted carefully. The buccal cortical bone is removed by osteotomy using a saw-type tip attached to a piezoelectric device (PED) at the same width as the distance of posterior repositioning. The osteotomy line is elongated in an L-shape toward the piriform aperture from a position approximately 5 mm superior to the apex of the canine tooth, and then the palatine bone is removed from the side of the removed buccal bone. For Le Fort I type osteotomy, horizontal vestibular mucosal incisions from canine to molar area are made in both sides. Osteotomy to move total maxillary alveolar segment is made with PED only in the maxillary anterior and posterior bony wall portion. Down fracture is performed with a pair of separators without a pterygomaxillary suture and nasal septum osteotomy. The bone fragments can be repositioned without dissecting the nasal septum, and a alar base cinch suture is no need.

Results and discussion: The use of bone burs and bone saws results frequently in heavy bleeding. A little bleeding is encountered with this method. Because the present surgical technique preserves blood supply to the bone fragments being repositioned from both the palatal and buccal mucosa, the method is safe and offers favourable outcomes. Furthermore, the soft tissue shape of upper lip and nose is preserved without the use of alar base cinch suture.