Maxillary Surgery

 

686. Maxillary Surgery

Maxillary surgery corrects the position and shape of the upper jaw to enhance facial harmony, occlusion, and aesthetics. The maxilla connects to the cheekbones laterally, surrounds the nasal area at the front, and is bordered internally by the maxillary sinus, which helps regulate temperature through ventilation.

When the upper jaw is underdeveloped, Le Fort I osteotomy is performed to advance the maxilla. This horizontal osteotomy enables forward or backward movement of the maxillary segment depending on the patient’s needs—whether to correct sunken midface or a protruding upper jaw. If the occlusal plane is tilted, the jaw can be rotated and fixed to align with the interpupillary line using wedge-shaped adjustments.

In cases where the protrusion is localized to the anterior maxilla (such as mild bimaxillary protrusion), anterior segmental osteotomy (ASO) may be performed instead. This involves extracting premolars and moving the front maxillary segment backward. Sometimes both Le Fort I and ASO are combined, dividing the maxilla into two or three segments for precise repositioning.

When the maxilla is too narrow—often seen in patients with cleft lip and palate and a history of multiple childhood surgeries—SARPE (Surgically Assisted Rapid Palatal Expansion) is used to widen the palate.

For congenital conditions like Crouzon or Treacher Collins syndrome with severely hypoplastic maxilla, Maxillary Distraction Osteogenesis helps lengthen the bone gradually.

Since repositioning the maxilla affects the bite, it’s often combined with mandibular surgeries like sagittal split or vertical ramus osteotomies to properly align the upper and lower jaws—this is known as bimaxillary surgery.

For patients with long midfaces or excessive gum show while smiling, upper jaw repositioning can involve upward movement and rotation to reduce gum exposure and improve smile aesthetics.

In older patients with short maxilla and missing teeth, titanium supports can be placed to hold dental implants, restoring bite function and facial volume for a more youthful appearance.

Maxillary surgery corrects jaws that are too long, short, forward, recessed, or rotated, bringing balance to the midface and alignment to the bite.

[Maxillary surgery sculpts the upper jaw for ideal proportion and harmony.]

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