Surgical buccinator muscle myotomy in dentoskeletal Class II alterations

Recent studies on autoptic findings have underlined the complexity of perioral muscles; the discovery of a fourth band of buccinator muscle and the effects it can have on teeth, alveolar bone, and oral mucosa during growth has stressed the importance of muscular influence on the genesis of and therapy for basal class II dentofacial alterations. Frederick proposed a surgical marginal myotomy to elongate the buccinator bundle together with inferior vestibuloplasty to unload the jaw from the overcontraction of the muscle and to reduce the inferior lip hypotone. In our investigation, we have applied this technique on a group of 50 patients with basal class II defect selected according to our protocol before functional or fixed orthodontics, and we have recorded and compared cephalometric measurements and clinical facial profile changes 12 (T1) and 24 (T2) months after the end of therapy to a control group with the same defect treated only with orthodontic functional devices. We obtained improvement of cephalometric parameters in 80% of patients who underwent surgery and orthodontics, and in only 50% of patients who underwent only orthodontics. Results suggest that neutralizing buccinator and mental muscles pressure on the jaw during growth can help the clinician dealing with II basal malocclusion therapy and relapse.