Why segment the maxilla between laterals and canines?

Abstract

Introduction: Maxillary surgery on a bone segment enables movement in the sagittal and vertical planes. When performed on multiple segments, it further provides movement in the transverse plane. Typical sites for interdental osteotomies are between laterals and canines, premolars and canines, or between incisors. Additionally, osteotomies can be bilateral, unilateral or asymmetric. The ability to control intercanine width, buccolingual angulation of incisors, and correct Bolton discrepancy are some of the advantages of maxillary segmentation between laterals and canines. Objective: This article describes important features to be considered in making a clinical decision to segment the maxilla between laterals and canines when treating a dentoskeletal deformity. It further discusses the history of this surgical approach, the indications for its clinical use, the technique used to implement it, as well as its advantages, disadvantages, complications and stability. It is therefore hoped that this paper will contribute to disseminate information on this topic, which will inform the decision-making process of those professionals who wish to make use of this procedure in their clinical practice. Conclusions: Segmental maxillary osteotomy between laterals and canines is a versatile technique with several indications. Furthermore, it offers a host of advantages compared with single-piece osteotomy, or between canines and premolars.

Oroantral Communication After Segmental Le Fort I Osteotomy

“…This reduces the risk of palatal perforation, particularly in transverse maxillary expansion. 5,8 In the case reported, it is possible to associate an inadequate use of osteotomes during the segmentation with a laceration of palatal mucosa.…”

“…The maxillary complications included direct injury to the dental root, pulpal injury, gingival recession, need to remove hardware, wound infection, wound dehiscence, aseptic necrosis, fibrous union, and oronasal fistula. [6][7][8] In a recent systematic review, Haas et al 5 verified that circumstances such as difficulty performing an osteotomy between the teeth and in areas adjacent to soft tissues mean that the most common complications of segmental maxillary osteotomy, such as oral fistula and dental injury do not occur with nonsegmental techniques. The Y-shaped cut is close to the midline of the hard palate where the bone is thick, and the palatal soft tissue is thin and tightly bound to the bone, whereas the U-shaped cuts are located further from the midline where the bone is thinner and the soft tissue thicker.…”

“…Complications after orthognathic surgery procedures, although uncommon, are present in the daily life of surgeons who perform this type of procedure. The maxillary complications included direct injury to the dental root, pulpal injury, gingival recession, need to remove hardware, wound infection, wound dehiscence, aseptic necrosis, fibrous union, and oronasal fistula 6–8 …”

Association Between Maxillary Segmentation and Perioperative Complications in Le Fort I Osteotomy

“…1). 6 Complications of Le Fort I may be immediate or delayed resulting from errors in treatment planning, trauma to adjacent anatomical structures, hardware malfunction, or patient-specific factors. Intra and postoperative complications include hemorrhage of the maxillary or descending palatine arteries, avascular necrosis of adjacent teeth or bony segment, nonunion, oronasal fistula formation, infection, or paresthesia of the infraorbital nerve.…”

Cone beam computed tomography evaluation of tooth injury after segmental Le Fort I osteotomy

“…Le Fort I osteotomy en bloc in conjunction with orthognathic surgery is a well-recognized procedure for the correction of developmental dentofacial deformi-ties 1,2 . According to the literature, modifying the procedure with interdental osteotomies may have several advantages [3][4][5][6][7][8] . Complications after segmentation are described as root injuries, tooth loss, periodontal injuries [9][10][11][12][13] , changes in alveolar crest height 14,15 , oronasal fistula 16 , and, in very rare cases, partial jaw necrosis 17,18 .…”