Odontologia

273
Naoto Suda, DDS, PhD
Assistant Professor

Chiharu Murakami, DDS
Clinical Fellow

Three cases of anterior maxillary osteotomy under orotracheal intubation

Tatsuo Kawamoto, DDS, PhD
Assistant Professor

Takahiro Takeshima, DDS
Clinical Fellow

Kenji Fukada, DDS, PhD
Instructor Maxillofacial Orthognathics Department of Maxillofacial Reconstruction and Function Division ofMaxillofacial/Neck Reconstruction

Kiyoshi Harada, DDS, PhD
Assistant Professor Oral Surgery Department of Oral Restitution Division of Oral Health Sciences

Kimie Ohyama, DDS, PhD
Professor and Chair Maxillofacial Orthognathics Department of Maxillofacial Reconstruction and Function Division of Maxillofacial/Neck Reconstruction Graduate School, Tokyo Medical and Dental University Tokyo, JapanAnterior maxillary osteotomy is frequently applied to skeletal Class II cases with maxillary protrusion. In addition to the anteroposterior problem, these cases are often accompanied with a long midfacial appearance and display of incisors and gingiva during smiling. In the application of anterior maxillary osteotomy to such patients, it is necessary to move the anterior maxillary segments upwardas well as backward. Since the upward movement occasionally interferes with the intranasal endotracheal tube, orotracheal intubation is recommended for the operation. Recently, the use of a resin replica of the mandibular dental arch was introduced to place the anterior maxillary segment correctly in the planned position and to obtain the correct occlusion. This article reports on 3 maxillaryprotrusive skeletal Class II patients with deep overbites and vertical esthetic problems treated by this method. The treatment results show that all 3 patients exhibited large upward and backward movements of the anterior maxillary segments and desirable facial profiles, with a reduction of the deep overbites after the treatment. This case report demonstrates that the anterior maxillary osteotomyunder orotracheal intubation with the use of a resin replica is a useful method to treat maxillary protrusive skeletal Class II patients with a large alveolar height. (Int J Adult
Orthod Orthognath Surg 2002;17:273–282)

Reprint requests:
Dr Naoto Suda Maxillofacial Orthognathics Department of Maxillofacial Reconstruction and Function Division of Maxillofacial/Neck Reconstruction, Graduate SchoolTokyo Medical and Dental University 1-5-45 Yushima, Bunkyo-ku Tokyo 113-8549, Japan Fax: +81-3-5803-5533 E-mail: n-suda.mort@tmd.ac.jp

Int J Adult Orthod Orthognath Surg Vol. 17, No. 4, 2002

Anterior maxillary osteotomy is frequently applied to cases of maxillary excess.1,2 Most of them exhibit skeletal Class II malocclusion with maxillary protrusion and proclined maxillary incisors. Inaddition to these anteroposterior problems, these cases are often accompanied by excessive vertical growth of the maxilla. This vertical excess causes a long midfacial appearance and the display of incisors and gingiva during smiling. To treat these patients, it is necessary to move the anterior maxillary segments upward as well as backward by anterior maxillary osteotomy. Since the upward movementoccasionally interferes with an intranasal endotracheal tube, orotracheal intubation is recom-

mended (Figs 1a and 1b). However, the critical problem of orotracheal intubation is the difficulty in examining the occlusion between the maxillary and mandibular teeth and in placing the anterior maxillary segment correctly in the arranged position during the operation. To solve this problem,application of a resin replica of the mandibular dental arch has been reported (Fig 1c).3 This method enables examination of the occlusion and helps to place the anterior maxillary segment correctly into the arranged position. This article reports on 3 maxillary protrusive skeletal Class II patients with deep overbites and vertical esthetic problems who were treated by this method.

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