Revisiting the Anterior Maxillary Subapical Osteotomy and Advancement Procedure

Anterior maxillary subapical osteotomy (AMSO) followed by premaxillary advancement is an orthognathic surgical procedure which has been undertaken rather infrequently in the recent past, owing to its being overtaken by premaxillary distraction osteogenesis (DO). It is most often employed in cleft cases with anteroposterior maxillary deficiency.

The procedure and technique of AMSO is also found to be amenable to modification, adaptation and incorporation as per specific requirements of individual cases. This case report describes its employment as an unusual and novel approach to treat a non-cleft maxillary deficiency case, as a case-specific technique.

The report thereby attempts to re-popularize the procedure, by elaborating its ease, efficacy, reliability, predictability, expedient outcome as well as long-term stability in premaxillary advancements. It can offer several advantages in treating mild to moderate Skeletal Class III Dentofacial Disharmony cases with marked Anterior Crossbite & Reverse Overjet, with its novelty lying in simplicity and straightforwardness of the procedure; immediately apparent esthetic results post-surgery; with practically nil complication and relapse rates.

Its results, in terms of correction of both, the esthetic deformity and functional impairment (in speech and mastication), are almost immediately apparent. Additionally, it can be modified to a 'Surgery First, Orthodontics After (SFOA)' protocol, to further reduce the total treatment duration and yield a speedy outcome, which is of particular benefit in young adult patients with an active lifestyle, offering a distinct psychological advantage by an immediate improvement in facial appearance, enunciation as well as masticatory function. This facilitates a ready patient acceptance for treatment and also encourages optimal patient compliance during the post-surgical orthodontic phase.