Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment
Identifieur interne : 000707 ( Pmc/Corpus ); précédent : 000706; suivant : 000708Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment
Auteurs : V. Sadesh Kannan ; G. R. Sathya Narayanan ; A. Saneem Ahamed ; K. Velaven ; E. Elavarasi ; C. DanavelSource :
- Journal of Pharmacy & Bioallied Sciences [ 0976-4879 ] ; 2014.
Abstract
The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO) markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment.
This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess), especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated.
All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints.
This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.
Url:
DOI: 10.4103/0975-7406.137403
PubMed: 25210348
PubMed Central: 4157244
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment</title><author><name sortKey="Kannan, V Sadesh" sort="Kannan, V Sadesh" uniqKey="Kannan V" first="V. Sadesh" last="Kannan">V. Sadesh Kannan</name><affiliation><nlm:aff id="aff1">Consultant Maxillofacial Surgeon, BeWell Hospitals, The Dental Clinic, Lawspet, Puducherry, India</nlm:aff></affiliation></author><author><name sortKey="Narayanan, G R Sathya" sort="Narayanan, G R Sathya" uniqKey="Narayanan G" first="G. R. Sathya" last="Narayanan">G. R. Sathya Narayanan</name><affiliation><nlm:aff id="aff2">Neu Face Hospitals, Thanjavur, India</nlm:aff></affiliation></author><author><name sortKey="Ahamed, A Saneem" sort="Ahamed, A Saneem" uniqKey="Ahamed A" first="A. Saneem" last="Ahamed">A. Saneem Ahamed</name><affiliation><nlm:aff id="aff3">Consultant Maxillofacial Surgeon, Appasamy Multispeciality Hospital, Arumbakkam, Chennai, India</nlm:aff></affiliation></author><author><name sortKey="Velaven, K" sort="Velaven, K" uniqKey="Velaven K" first="K." last="Velaven">K. Velaven</name><affiliation><nlm:aff id="aff4">Impacts 32 Dental Clinic, Old Pallavaram, Chennai, India</nlm:aff></affiliation></author><author><name sortKey="Elavarasi, E" sort="Elavarasi, E" uniqKey="Elavarasi E" first="E." last="Elavarasi">E. Elavarasi</name><affiliation><nlm:aff id="aff5">Consultant Oral and Maxillofacial Radiologist, Lawspet, Pondicherry, India</nlm:aff></affiliation></author><author><name sortKey="Danavel, C" sort="Danavel, C" uniqKey="Danavel C" first="C." last="Danavel">C. Danavel</name><affiliation><nlm:aff id="aff6">Consultant Endodontist, DJ Dental Clinic, Reddiyarpalayam, Pondicherry, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25210348</idno><idno type="pmc">4157244</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157244</idno><idno type="RBID">PMC:4157244</idno><idno type="doi">10.4103/0975-7406.137403</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000707</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000707</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment</title><author><name sortKey="Kannan, V Sadesh" sort="Kannan, V Sadesh" uniqKey="Kannan V" first="V. Sadesh" last="Kannan">V. Sadesh Kannan</name><affiliation><nlm:aff id="aff1">Consultant Maxillofacial Surgeon, BeWell Hospitals, The Dental Clinic, Lawspet, Puducherry, India</nlm:aff></affiliation></author><author><name sortKey="Narayanan, G R Sathya" sort="Narayanan, G R Sathya" uniqKey="Narayanan G" first="G. R. Sathya" last="Narayanan">G. R. Sathya Narayanan</name><affiliation><nlm:aff id="aff2">Neu Face Hospitals, Thanjavur, India</nlm:aff></affiliation></author><author><name sortKey="Ahamed, A Saneem" sort="Ahamed, A Saneem" uniqKey="Ahamed A" first="A. Saneem" last="Ahamed">A. Saneem Ahamed</name><affiliation><nlm:aff id="aff3">Consultant Maxillofacial Surgeon, Appasamy Multispeciality Hospital, Arumbakkam, Chennai, India</nlm:aff></affiliation></author><author><name sortKey="Velaven, K" sort="Velaven, K" uniqKey="Velaven K" first="K." last="Velaven">K. Velaven</name><affiliation><nlm:aff id="aff4">Impacts 32 Dental Clinic, Old Pallavaram, Chennai, India</nlm:aff></affiliation></author><author><name sortKey="Elavarasi, E" sort="Elavarasi, E" uniqKey="Elavarasi E" first="E." last="Elavarasi">E. Elavarasi</name><affiliation><nlm:aff id="aff5">Consultant Oral and Maxillofacial Radiologist, Lawspet, Pondicherry, India</nlm:aff></affiliation></author><author><name sortKey="Danavel, C" sort="Danavel, C" uniqKey="Danavel C" first="C." last="Danavel">C. Danavel</name><affiliation><nlm:aff id="aff6">Consultant Endodontist, DJ Dental Clinic, Reddiyarpalayam, Pondicherry, India</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Pharmacy & Bioallied Sciences</title><idno type="ISSN">0976-4879</idno><idno type="eISSN">0975-7406</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Aim:</title><p>The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO) markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess), especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated.</p></sec><sec id="st3"><title>Results:</title><p>All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints.</p></sec><sec id="st4"><title>Conclusion:</title><p>This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Steinh User, Ew" uniqKey="Steinh User E">EW Steinhäuser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thyne, Gm" uniqKey="Thyne G">GM Thyne</name></author><author><name sortKey="Ferguson, Jw" uniqKey="Ferguson J">JW Ferguson</name></author><author><name sortKey="Pilditch, Fd" uniqKey="Pilditch F">FD Pilditch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wundere, S" uniqKey="Wundere S">S Wundere</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Phillips, C" uniqKey="Phillips C">C Phillips</name></author><author><name sortKey="Broder, Hl" uniqKey="Broder H">HL Broder</name></author><author><name sortKey="Bennett, Me" uniqKey="Bennett M">ME Bennett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilhelm, W" uniqKey="Wilhelm W">W Wilhelm</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Pharm Bioallied Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Pharm Bioallied Sci</journal-id><journal-id journal-id-type="publisher-id">JPBS</journal-id><journal-title-group><journal-title>Journal of Pharmacy & Bioallied Sciences</journal-title></journal-title-group><issn pub-type="ppub">0976-4879</issn><issn pub-type="epub">0975-7406</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25210348</article-id><article-id pub-id-type="pmc">4157244</article-id><article-id pub-id-type="publisher-id">JPBS-6-107</article-id><article-id pub-id-type="doi">10.4103/0975-7406.137403</article-id><article-categories><subj-group subj-group-type="heading"><subject>Dental Science - Original Article</subject></subj-group></article-categories><title-group><article-title>Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kannan</surname><given-names>V. Sadesh</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Narayanan</surname><given-names>G. R. Sathya</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Ahamed</surname><given-names>A. Saneem</given-names></name><xref ref-type="aff" rid="aff3">2</xref></contrib><contrib contrib-type="author"><name><surname>Velaven</surname><given-names>K.</given-names></name><xref ref-type="aff" rid="aff4">3</xref></contrib><contrib contrib-type="author"><name><surname>Elavarasi</surname><given-names>E.</given-names></name><xref ref-type="aff" rid="aff5">4</xref></contrib><contrib contrib-type="author"><name><surname>Danavel</surname><given-names>C.</given-names></name><xref ref-type="aff" rid="aff6">5</xref></contrib></contrib-group><aff id="aff1">Consultant Maxillofacial Surgeon, BeWell Hospitals, The Dental Clinic, Lawspet, Puducherry, India</aff><aff id="aff2"><label>1</label>Neu Face Hospitals, Thanjavur, India</aff><aff id="aff3"><label>2</label>Consultant Maxillofacial Surgeon, Appasamy Multispeciality Hospital, Arumbakkam, Chennai, India</aff><aff id="aff4"><label>3</label>Impacts 32 Dental Clinic, Old Pallavaram, Chennai, India</aff><aff id="aff5"><label>4</label>Consultant Oral and Maxillofacial Radiologist, Lawspet, Pondicherry, India</aff><aff id="aff6"><label>5</label>Consultant Endodontist, DJ Dental Clinic, Reddiyarpalayam, Pondicherry, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. V. Sadesh Kannan E-mail: <email xlink:href="sadeshkannan@gmail.com">sadeshkannan@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2014</year></pub-date><volume>6</volume><issue>Suppl 1</issue><fpage>S107</fpage><lpage>S109</lpage><history><date date-type="received"><day>30</day><month>3</month><year>2014</year></date><date date-type="rev-recd"><day>30</day><month>3</month><year>2014</year></date><date date-type="accepted"><day>09</day><month>4</month><year>2014</year></date></history><permissions><copyright-statement>Copyright: © Journal of Pharmacy and Bioallied Sciences</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Aim:</title><p>The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO) markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment.</p></sec><sec id="st2"><title>Materials and Methods:</title><p>This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess), especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated.</p></sec><sec id="st3"><title>Results:</title><p>All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints.</p></sec><sec id="st4"><title>Conclusion:</title><p>This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.</p></sec></abstract><kwd-group><title>KEY WORDS</title><kwd>Anterior maxillary osteotomy</kwd><kwd>bird wing segment</kwd><kwd>superior repositioning</kwd></kwd-group></article-meta></front><body><p>The anterior maxillary osteotomy (AMO) is employed primarily to reposition the anterior dento-osseous segment posteriorly. It is also used to move the segment superiorly or inferiorly as indicated. The first reported anterior segmental maxillary osteotomy was performed in 1921 by Cohn-Stock,[<xref rid="ref1" ref-type="bibr">1</xref>] wherein a wedge of palatal bone was removed through transverse palatal incision and the anterior maxillary segment was retracted through elastic force. Several approaches for AMO has been advocated like Wassmund's[<xref rid="ref2" ref-type="bibr">2</xref>] technique introduced in 1927, Wundere's[<xref rid="ref3" ref-type="bibr">3</xref>] technique in 1963 and Cupar's technique in 1954 is the most preferred approach by many surgeons as it allows access for bone removal under direct visualization through the nasal floor. The bone from the lateral, superior, and posterior palatal surfaces are removed in slice until the premaxilla segment is placed in predetermined position as indicated by prefabricated splint. This maneuvering of bone removal by a trial and error method increases the operating time, leading to prolonged kinking on the palatal pedicle with resultant compromise to the vascularity of the anterior segment.</p><p>This bird wing segment technique is a simple procedure, which allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion to the osteotomy segment.</p><sec sec-type="materials|methods" id="sec1-1"><title>Materials and Methods</title><sec id="sec2-1"><title>Materials</title><p>Study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio is 8:12, with a mean age of 25-30 years. All patients were involved in presurgical orthodontics and the patients who have a gummy smile with the incisal show more than 8 mm when the lip is at repose (rest position) were involved in the study and also the patients:</p><list list-type="order"><list-item><p>Who wants the immediate esthetic improvement due to age bar for marriage in India, especially females nearly 30 years)</p></list-item><list-item><p>Who were not satisfied with the orthodontic treatment and insisted for surgical correction and also if they are fit for it</p></list-item><list-item><p>Who were having edentulous posteriors</p></list-item><list-item><p>Who were not indicated for Lefort-I osteotomy (Anemic or due to expecting posterior open bite or going for extensive surgery like three piece Lefort-I osteotomy or need for adjunct mandibular sub-apical osteotomy).</p></list-item></list></sec><sec id="sec2-2"><title>Methods</title><p>This bird wing segment technique is performed following presurgical orthodontics[<xref rid="ref4" ref-type="bibr">4</xref>] under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess), especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm.[<xref rid="ref5" ref-type="bibr">5</xref>] After conventional primary AMO cut was performed, the precise calculated height of bone is removed just 5 mm above the root apices, from the anterior nasal spine, nasal floor, and the pyriform rim in a single bird wing shape segment and fixed with 2-hole plate one on either side of the pyriform rim.</p><p>For example, [<xref ref-type="fig" rid="F1">Figure 1</xref>] in a case where the incisal show is revealed as 10 mm when the lip is at repose, whereas the preferred amount of an incisal show is only 2 mm. This is achieved by superior repositioning of the premaxilla by 8 mm [<xref ref-type="fig" rid="F2">Figure 2</xref>]. The clinically calculated 8 mm [<xref ref-type="fig" rid="F3">Figure 3</xref>] to superiorly repositioning of the dentoalveolar segment, in a predetermined position with perfect alignment to the basal bone in end-to-end contact thereby providing maximum stability with minimum hardware of 2-hole plate one on either side of the pyriform rim [<xref ref-type="fig" rid="F4">Figure 4</xref>].</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>10 mm of incisal show when lip is at repose</p></caption><graphic xlink:href="JPBS-6-107-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Osteotomy cut of 8 mm for superior repositioning of premaxilla</p></caption><graphic xlink:href="JPBS-6-107-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>Single piece of ‘Bird-Wing’ like osteotomized segment</p></caption><graphic xlink:href="JPBS-6-107-g003"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p>Stabilization with 2-hole plate in pyriform rim of both sides</p></caption><graphic xlink:href="JPBS-6-107-g004"></graphic></fig></sec></sec><sec sec-type="results" id="sec1-2"><title>Results</title><p>All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints.</p></sec><sec sec-type="conclusion" id="sec1-3"><title>Conclusion</title><p>This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor to superiorly repositioning of the dentoalveolar segment in a predetermined position with perfect alignment to the basal bone in end-to-end contact thereby providing maximum stability with minimum hardware of 2-hole plate one on either side of the pyriform rim markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good vascularity.</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steinhäuser</surname><given-names>EW</given-names></name></person-group><article-title>Historical development of orthognathic surgery</article-title><source>J Craniomaxillofac Surg</source><year>1996</year><volume>24</volume><fpage>195</fpage><lpage>204</lpage><pub-id pub-id-type="pmid">8880445</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thyne</surname><given-names>GM</given-names></name><name><surname>Ferguson</surname><given-names>JW</given-names></name><name><surname>Pilditch</surname><given-names>FD</given-names></name></person-group><article-title>Endotracheal tube damage during orthognathic surgery</article-title><source>Int J Oral Maxillofac Surg</source><year>1992</year><volume>21</volume><fpage>80</fpage><pub-id pub-id-type="pmid">1602164</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wundere</surname><given-names>S</given-names></name></person-group><article-title>Die prognathic peration mittels frontal gestieltem maxilla fragment</article-title><source>Osterr Z Stomatol</source><year>1962</year><volume>39</volume><fpage>98</fpage></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Phillips</surname><given-names>C</given-names></name><name><surname>Broder</surname><given-names>HL</given-names></name><name><surname>Bennett</surname><given-names>ME</given-names></name></person-group><article-title>Dentofacial disharmony: Motivations for seeking treatment</article-title><source>Int J Adult Orthodon Orthognath Surg</source><year>1997</year><volume>12</volume><fpage>7</fpage><lpage>15</lpage><pub-id pub-id-type="pmid">9456613</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wilhelm</surname><given-names>W</given-names></name></person-group><article-title>The surgical treatment of the prognathism of the maxilla</article-title><source>Bol Odontol</source><year>1954</year><volume>20</volume><fpage>146</fpage></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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