Functional and morphologic alterations after anterior or inferior repositioning of the maxilla

The purpose of this investigation was 1) to compare functional and morphologic measurements between controls and patients scheduled for anterior or inferior repositioning of the maxilla, and 2) to examine how these patients' oral function adapted after surgery.

Nine male patients undergoing anterior and/or inferior repositioning of the maxilla were compared with 26 male controls preoperatively and up to 3 years after surgery. Measures of skeletal morphology, mandibular range of motion, maximum voluntary bite force, and levels of electromyographic (EMG) activity in the anterior and posterior temporalis and masseter muscles during isometric bites were made on all subjects over time. One-way ANOVA was used to compare the controls, the patients before surgery, and the patients after surgery.

Before surgery, most of the patients had morphologic characteristics of mandibular prognathism and maxillary retrognathism. Surgery made the patients' skeletal morphology similar to controls except for mandibular length, upper facial height, and palatal plane angle, which were significantly greater than those of controls. There were no significant differences in jaw muscle mechanical advantage between controls and patients either before or after surgery. Hypomobility of the jaw was apparent at 6 weeks and 6 months after surgery, but returned to normal values within 1 to 2 years. Before surgery, the patients had maximum voluntary bite forces significantly less than those of controls. Bite forces in patients steadily increased after surgery, approaching significantly higher values than those of controls. Before surgery, patients' muscle activity levels per unit of bite force were not significantly different from those of controls. Most of the patients' muscle activity levels per unit of bite forces at all bite positions showed no significant change after surgery.

The results of this study suggest that anterior or inferior repositioning of maxilla produces some significant functional benefits in patients.