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The maxilla is a paired bone that forms a significant portion of the midface. It articulates with the frontal, zygomatic, palatine bone, and sphenoid bones. The Le Fort I segment, the portion of the maxilla mobilized during the osteotomy, receives its blood supply primarily from the ascending palatine artery (a branch of the facial artery) and the anterior branch of the ascending pharyngeal ...
Orthognathic surgery is performed by maxillofacial or an oral surgeon or a plastic surgeon in collaboration with an orthodontist. It often includes braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies ...
Maxillomandibular advancement (MMA) or orthognathic surgery, also sometimes called bimaxillary advancement (Bi-Max), or maxillomandibular osteotomy (MMO), is a surgical procedure or sleep surgery which moves the upper jaw and the lower jaw forward.
Bite changes occur in 20.3% of the cases post-setback surgery. [37] Change in pharyngeal airway space and tongue position can have a significant effect on bite changes after mandibular setback surgery and cause obstructive sleep apnea. [1] [38] [39] The tongue is normally positioned against the roof of the mouth, supporting the upper jaw.
However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment. [55] Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess.
A second repair can sometimes be required; causes are recurrence of cancer, new cancer or new trauma. A second flap can be harvested from the contralateral forehead after a prior vertical flap. [1] If an oblique or angled flap was used during the first surgery, the second repair becomes more difficult.
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Maxillary expansion is indicated in cases with a difference in the width of the upper jaw to the lower jaw equal to or greater than 4 mm. Typically this is measured from the width of the outside of the first molars in the upper jaw compared to the lower jaw taking into account that the molars will often tip outward to compensate for the difference.