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. 2009 Feb;23(1):32-9.
doi: 10.1055/s-0028-1110099.

Bimaxillary protrusion: an overview of the surgical-orthodontic treatment

Yong-Ming Chu  1 , Léonard Bergeron, Yu-Ray Chen
Affiliations

Bimaxillary protrusion: an overview of the surgical-orthodontic treatment

Yong-Ming Chu et al. Semin Plast Surg. 2009 Feb.

Abstract

Bimaxillary protrusion is a commonly seen deformity in Asian populations. This condition is characterized by protrusive and proclined upper and lower incisors and an increased procumbency of the lips. It is usually combined with lip incompetence, gummy smile, mentalis strain, and anterior open bite. Facial aesthetics is the primary concern of these patients. Successful treatment depends on a thorough evaluation and understanding of this dentofacial deformity. Typical orthodontic treatment includes retraction and retroclination of maxillary and mandibular incisors after extraction of the four first premolars. Orthognathic surgery is required to correct significant skeletal problems. Anterior subapical osteotomies and extraction of premolars can correct sagittal excess of the jaw bones and relieve dental crowding. Segmental maxillary osteotomies are performed to treat patients with an associated exaggerated curve of Spee and vertical maxillary excess. Differential intrusion of anterior and posterior maxilla/maxillary segments with clockwise rotation of the occlusal plane is a useful technique for treatment of anterior open bite and creation of a consonant smile arc. Le Fort I osteotomy with setback sometimes provides an alternative to segmental maxillary osteotomies. Meticulous planning and execution of osteotomies in accordance with surgical planning are essential for aesthetic and functional outcome.

Keywords: Asian; Bimaxillary protrusion; Kölle; Wassmund; aesthetic surgery; one-splint technique.

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Figures

Figure 1
Figure 1
(A) A 24-year-old woman with bimaxillary protrusion. Preoperative frontal view. (B) Preoperative profile view. (C) Preoperative frontal smile. Note the relatively flat smile arc and gummy smile. (D) Twelve months after Le Fort I three-piece osteotomy, Kölle procedure, and genioplasty; postoperative frontal view. (E) Postoperative profile view. (F) Postoperative frontal smile. Note the consonant smile arc.
Figure 2
Figure 2
Marking the osteotomy lines for the Kölle procedure.
Figure 3
Figure 3
Le Fort I osteotomy.
Figure 4
Figure 4
(A) Osteotomy of the pterygomaxillary suture with a right-angle oscillating saw. (B) Pterygomaxillary disjunction with a Dautrey-Munro osteotome.
Figure 5
Figure 5
Creation of a palatal tunnel for the Wassmund procedure.
Figure 6
Figure 6
Marking the osteotomy lines for the Wassmund procedure. Note the wedge-shaped ostectomy area.
Figure 7
Figure 7
Parasagittal split of posterior maxillary segments.
Figure 8
Figure 8
(A) Facial proportions. (B) Rickett’s E-line in Asians.
Figure 9
Figure 9
The plate and screw fixation for BSSO.
See this image and copyright information in PMC

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