Definitive surgical correction of vertical maxillary deficiency

Inferior repositioning of the maxilla to correct vertical maxillary deficiency has been associated with variable degrees of instability and subsequent relapse. Resorption of bone-graft material has been incriminated as the primary cause of postoperative instability. This paper reports on nine patients who have undergone inferior maxillary repositioning resulting in no residual bone contact between the down-fractured maxilla and superior midface. Mean inferior maxillary repositioning was 6.2 mm. Osteotomy gaps were implanted with porous block hydroxyapatite (Interpore 200), and maxillae were rigidly fixed in position with miniplates. No postoperative intermaxillary fixation was utilized in any patient. Follow-up ranged from 11 to 28 months, with a mean of 19.6 months. Cephalometric analyses at follow-up revealed excellent stability of the repositioned maxillae, with a mean vertical relapse of 4.3 percent. No complications were associated with this procedure. The biomechanical rationale contributing to the success of this operative technique is discussed.