Orthognatic surgery: anterior segmental osteotomy

Introduction: Segmental osteotomy is a surgical procedure of dentomucoalveolar or mucoalveolar flap movement to another position inside the maxilla.

Objective: Case report of anterior segmental osteotomy in a patient with anterior, posterior and transversal maxillary hypoplasia, laterognatia, border to border bite, Angle’s class III occlusion and TMJ dysfunction.

Case report. Background: In 1927 Wasmund proposed to mobilize the upper anterior alveolar segment with corrective purposes for overjets. Around 1969–1971 Dr. William Bell observed revascularization of the osteotomized segments with only one vascular support.

Patient, materials and methods: 50 year old male with chewing disorder and a TMJ bilateral pain. After conservative treatment of TMJ dysfunction, an orthognatic bimaxillary surgery was proposed, the patient only accepted maxilla correction. Mucoperiostic circumvestibular maxillary flap, Lefort I osteotomy, vertical ostetomy at incisive and canine levels with a horse shoe form in the palate vault. After obtaining segment mobilization, a previously designed surgical guide was placed along with intermaxillary fixation and wire. After correct condilar position was assured, segments were fixated with titanium mini plates in L form 2.0 and 1.5 system. (Diagnostic Method): Lateral and posteroanterior cephalogram, physical examination and laboratory exams.

Results: Satisfactory. Angle’s Class I occlusion, facial symmetry.

Conclusions: Anterior Segmental osteotomy is a useful procedure in the management of dental facial deformities. One of the advantages of this technique is to move the segments three dimensionally. Can be used in cases with vertical and sagittal dysplasias, one disadvantage is the loss of interdental crestal height in the interproximal osteotomy sites in cases where extractions are not performed.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Orthognatic surgery: anterior segmental osteotomy
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