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Although Le Fort I osteotomy is performed to correct vertical maxillary alveolar excess (VMAE) in patients with a gummy smile and high palate, this procedure carries the risk of nasal cavity constriction. A combined Le Fort I and horseshoe osteotomy is complicated. On the other hand, although total maxillary alveolar osteotomy (TMAO), which was reported by Wolford and Hall, can improve VMAE without causing nasal cavity constriction, correctly performing one-stage osteotomy is very difficult because of difficulty in obtaining a sufficient surgical field with maintenance of the blood supply. Therefore, we have devised a two-stage procedure for TMAO. In this procedure, osteotomy of the palatine bone is performed initially, followed by another osteotomy of the buccal side after wound healing. In this study, the accuracy of superior repositioning and the postoperative stability of the maxilla obtained by two-stage TMAO in patients with a gummy smile were found to be excellent. Therefore, we consider two-stage TMAO to be an effective procedure for correcting a gummy smile accompanied by VMAE.

nihon koukuu geka gakkai zasshi/nippon kōkū geka gakkai zasshi

Investigation of two-stage total maxillary alveolar osteotomy for superior repositioning of the maxilla in patients with a gummy smile accompanied by a high palate