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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2005 January-December;16(1-3):3-8
Maxillary setback osteotomy with fracture of pterigoid processes
Brusati R., Biglioli F., Autelitano L., Colletti G.
Maxillofacial Surgery Department San Paolo Hospital, Milan, Italy
In some cases a sagittal maxillary overgrowth can cause a facial deformity characterized by an acute nasal-labial angle, a protruded upper lip and a gummy smile. The patient typically present a 2nd class occlusion as is in mandibular hypoplasia, a condition with totally different clinical manifestations. The most commonly adopted surgical correction for a maxillary sagittal excess consist in a LeFortI osteotomy associated with bilateral first premolar extraction and bone segmentations. This as well as other similar techniques have inherent risks such as radicular lesions, periodontal resorptions, teeth pulp necrosis, pseudoarthrosis and avascular necrosis of the osteotomized bone. There are only few reports in the literature regarding the LeFortI osteotomy with posterior repositioning of the entire maxilla. This procedure allows the correction of the occlusal disturbance and does not present the risks of the other procedures. Posterior repositioning can be obtained by fracturing and posteriorly dislocating the pterigoid processes. This is described as a risky procedure but, in our experience, if performed trough particular technical steps, is to be considered as safe and quick. The authors present their clinical experience in selected cases treated by means of this technique.