ANTERIOR SEGMENTAL MAXILLARY OSTEOTOMY.pptx

OMFS

1. ANTERIOR SEGMENTAL MAXILLARY OSTEOTOMY PRESENTED BY DINESH VENKATESAN FINAL YEAR BDS MAXILLARY OSTEOTOMY

2. HISTORICAL EVIDENCE 1921 – Cohn Stock performed first maxillary ostetomy Wedge shaped maxillary Osteotomy through transverse palatal incisions Succeeded by green stick fracture of Anterior maxillary segment that was retracted Relapsed in 4 weeks

3. INDICATIONS In Correction of Protrusion of Maxillary Anterior Teeth with normal axial inclination with alveolar bone. In Correction of Anterior Open Bite provided absence of maxillary excess. Vertical Plane Premaxilla correction – Openbite / Deep Bite. Failure in Orthodontic Therapy due to Ankylois or Pathological Resortion of Maxillary Anterior Teeth. To improve Facial Appearance in prognathic maxilla with competent lips and adequate lip length.

4. Techniques in AMO Wassmund Technique Wunderer Technique Cupar’s Technique

5. WASSMUND TECHNIQUE Vertical Incision between Canine and Premolar extending to nasal floor. Mucoperiosteum is reflected posteriorly. In apical region of canine, reflection is made till nasal pyriform aperture. First Premolars are extracted (if planned) at this stage

6. Midline Sagittal Incision is made anteroposteriorly on palate to perform palatal osteotomy. Palatal Mucosa is reflected and care is taken not to injure anterior palatine vessels.

7. Bony Cut is made on buccal aspect of alveolus. Cut is taken vertically upwards and turned medially to pyriform aperture so that 3-5 mm of bone remains intact in canine apex. Transpalatal osteotomy of palatal bone from alveolus of one side to other side. As advancing to midline osteotomy becomes hard dure to thickness of bone and access difficulty which is overcome by Midpalatine insidion made early.

8. Maxillary segment is now separated from nasal septum by finger pressure sometimes. Usually Vertical incision is placed over anterior nasal spine; mucoperiosteum is reflected from nasal spine & cartilaginous nasal septum. Nasal Osteotome is used to separate anterior maxillary segment and nasal septum. Folds of soft tissue are checked for proper blood supply and closed using catgut 3-0

9. WUNDERER TECHNIQUE Used especially when second premolar is extracted Labial Approach is similar to Wassmund Technique. Palatal Surgery is started after Buccal part of Surgery.

10. Here Transverse Palatal Cut anterior to planned osteotomy site. In midline bone is little harder but access is good and cut can done as posterior as second premolar. Anterior Segment can be mobilized and separated from nasal septum. It is then postioned & fixed using prefabricated occlusal splints.

11. Cupar’s Technique Buccal Vestibular Incision is created. Nasal Mucosa is elevated from superior surface of maxilla. Vertical Osteotomy is done. Through this vertical cut, transpalatal osteotomy is completed using osteotome or reciprocating saw. A finger is placed on palatal mucosa to palpate the osteotome to prevent palatal tissue damage.

12. AMO FIXATION OCCLUSAL STENT STABILIZATION OSSEOUS WIRING SKELETAL FIXATION REIGID INTERNAL FIXATION

13. ADVANTAGES Direct access to nasal structures Preservation of blood supply through excellent palatal pedicle. Ability to remove palatal none directly after down fracture of anterior maxilla. Excellent access to superior maxilla. Easy placement of rigid fixation.

14. COMPLICATIONS Loss of Vitality Damage to Tooth Roots Persistent Periodontal Problmes Osseous Necrosis of Dento -osseous segments Communication of nasal cavity and maxillary sinus Hemorrhage Oronasal or Oroantral Fistulas Atrophic Rhinitis Nasal Septal Deviation Unfavorable nasal esthetics