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tion, a stable occlusion, and clinical stability of the maxilla.
Fig 2 Modification of Le forte I osteotomy technique for corrector of skeletal-type anterior open bite or total maxillary alveolar hyperplasia. A: Dental and skeletal characteristics of skeletal type anterior open bite deformity. Stippled areas indicate osteotomy sites. B, C: Horizontal incision through mucooperosteum in buccolabial aspect of depth of vestibule. Horizontal supraapostecomy of later a maxilla extends from piriform rim posteriorly to pterygomaxillary fissure amount of bone to be ecised is determine from section models before surgery. D, E: Medial antral wall sectioned 3 to 4 mm above palatal roots and nasal floor through bony window created by buccal ostectomy.
■ Applications of Technique
With the maxilla in the "downfractured" position, many technical modifications of maxillary osteotomies are feasible - the maxilla is easily sectioned sagitally, transversely, or circumpalatally to facilitate simultaneous movement of the anterior and posterior maxillary dento-alveolar segments (Fig 2-4). Simultaneous anterior and posterior maxillary osteotomies, combined with extraction of first or second premolars, can frequently facilitate correction of severe occlusal problems with associated buccal or palatal crossbites in a single operation. The anterior and posterior maxillary dento-alveolar segments can be moved anteriorly, posteriorly, laterally, medially, superiorly, or inferiorly into the desired position. Severely rotated or crowded teeth and leveling of the lower arch, however, are usually best treated by preoperative or postoperative orthodontics.

Fig 3 A, B: Separation of nasal septum from superior part of maxilla with osteotome placed parallel with hard palate. C, D: Posterior lateral nasal wall sectioned with osteotome. E: Separation of maxilla from the pterygoid plate with osteotome. Surgeen’s finger is positioned below palatal mucosa to feel osteotome as it transsects bone.

Fig 4 – A: Maxilla in “downfracture” position. Mucoperiosteum has been detached and rewacted away from superior surface of maxilla and horizaongtal plate of palatine bone. B: Vertical ostectomy in premolar extraction site. Digital pressure is on palatal mucosa to feel bur when it sections the bone. C: Anterior and posterior maxillary ostectomies and osteotomics of maxilla with deep palatal vault. Sagittal osteotomies are made through maxillary sinus into oral cavity from tuberosity anteriorly to vertical ostectomy in premolar region; vertical ostectomies are connected by transverse palatal ostectomy. Surgion’s finger is placed on palatal mucosa to protect vascular pedicle and to feel bur as it transsects palatal bone. Horizongtal portion of palate remains attached to palatal mucosa. D: Sectioning of maxilla with low palatal vault. Sagittal bone incisions are made into nasal cavity; horizontal horizontal portion of hard palate remains pedtcled to palatal mucosa.

Table Treatments used to correct deformities of the maxilla in 15 patient since 1971.
Gate
no
Age
Race
Sex Dental
Facial
deformity
Etiology
Movement of maxilla(mm)
treatment
Complications
Follow-up (month)
1 16 W M MR Developmental Anterior,10 1,2,4 29
2 21 W F MAH Developmental Superior, 7 1 3
3 21 W F MR,MP Developmental Anterior, 6 1,2,4,6,7 Increased width
of mandib