Surgical procedures for correcting vertical maxillary excess: A review

Nisrina Ekayani Nasrun; Shigehiro Takeda; Yasuhito Minamida; Daichi Hiraki; Naohiro Horie; Hiroki Nagayasu; Tsuyoshi Shimo

doi:10.1016/j.ijscr.2021.106354

Surgical procedures for correcting vertical maxillary excess: A review

Int J Surg Case Rep. 2021 Sep:86:106354. doi: 10.1016/j.ijscr.2021.106354. Epub 2021 Aug 26.

Authors

Nisrina Ekayani Nasrun¹, Shigehiro Takeda¹, Yasuhito Minamida², Daichi Hiraki¹, Naohiro Horie¹, Hiroki Nagayasu², Tsuyoshi Shimo³

Affiliations

¹ Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
² Division of Oral and Maxillofacial Surgery, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
³ Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan. Electronic address: shimotsu@hoku-iryo-u.ac.jp.

Abstract

Introduction: Vertical maxillary excess, a common orthodontic problem that leads to long faces and open bites, can be repositioned with a Le Fort I osteotomy. However, the Le Fort I osteotomy poses the risk of a variety of complications including descending palatine artery (DPA) injury. Although several Le Fort I osteotomy modifications were reported to avoid complications associated with this osteotomy, only a few of such studies were conducted in Japan, and details remain scarce.

Patients and methods: We performed a literature review regarding modifications of Le Fort I osteotomies, including Le Fort I with a horseshoe osteotomy, modified horseshoe osteotomy, unilateral horseshoe osteotomy, pyramidal osteotomy, and U-shaped osteotomy. We identified eight relevant studies conducted in Japan; one study did not provide the number of patients examined. The 77 patients (seven studies) with vertical maxillary excess who underwent orthognathic surgery were ≥17 years old.

Discussion: There were no severe complications after the modified Le Fort I osteotomies. The postoperative maxillary changes obtained by the conventional horseshoe, modified horseshoe, unilateral type of horseshoe, pyramidal, and U-shaped osteotomies were nearly repositioned to the planned position and remained stable for ≥12 months post-surgery.

Conclusion: Our review indicates that preserving the DPA can lower the incidence of intra- and post-operative complications. Each modification of the Le Fort I osteotomy (i.e., conventional horseshoe, modified horseshoe, unilateral horseshoe, pyramidal, and U-shaped osteotomy) has its respective advantages and indications.

Keywords: Horseshoe osteotomy; Le fort I; Vertical maxillary excess.