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One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New
Max Domingues Pereira1, Vivian Farfel2, Gabriela Pereira Ribeiro Prado2
1Plastic Surgeon and Head, Craniomaxillofacial Unit, Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil.
Purpose:
To describe a retrospective assessment of the long-term stability of a new approach using wire fixation for 1-step surgical correction of transverse and anteroposterior maxillary deficiencies.
Patients And Methods:
The authors implemented a case series of 5 adult patients (3 men and 2 women; mean age, 31.4 yr) needing maxillary advancement less than 5 mm and had transverse maxillary deficiency greater than 7 mm who underwent total Le Fort I and median palatal suture osteotomies and had their maxilla advanced and stabilized bilaterally with stainless steel wire. Transverse expansion was performed using a Hyrax expander, which also was used for retention for 4 months after completion of the planned expansion. Follow-up included clinical examination and studies of lateral radiographs and plaster models preoperatively (T0), soon after completion of maxillary expansion (T1), 4 months after T1 (T2), 12 months after T1 (T3), and an average of 4.8 years (minimum, 4 yr 1 month; maximum, 5 yr; standard deviation, 0.3 yr) after T1 (T4).
Results:
Maxillary expansions measured at the most cervical points on the palatal face of the upper first premolars and of the upper first molars at T2 were 7.8 and 7.4 mm on average, respectively. In all cases, surgery promoted maxillary anteroposterior advancement. Anteroposterior maxillary skeletal measurements of the angle formed by the sella, nasion, and A point; the distance from the vertical reference line to the A point (A-VRL); the distance of the VRL to the cementoenamel junction (CEJ); and the distance from the perpendicular line of the nasion (Nperp) to the CEJ showed a substantially increase at T1 (P < .05) and stability at T2, T3, and T4; however, A-VRL presented a significant relapse at T4 compared with T1 (P = .037) and T2 (P = .027). The soft tissues expanded at the same rate as the skeletal tissues. The anteroposterior soft tissue measurements Nperp to superior lip and Nperp to the A' point showed a substantial increase at T2 (P < .05) and stability at T3 and T4. The measurements associated with anteroposterior correction were stable at T4.
Conclusion:
The proposed technique provides long-term stability of maxillary expansion and anteroposterior repositioning with only 1 surgical intervention. However, considering the small number of patients, a multicenter study is needed before a definitive conclusion can be reached.
