Patients with a long face and open bite often undergo posterior-superior repositioning of the maxilla in orthognathic surgery. In this paper, we report an analysis of cases of posterior-superior repositioning of the maxilla at Matsuda Orthopedic Memorial Hospital from June 2004 to December 2018. The results were as follows: 1．There were 44 patients who had undergone orthognathic surgery for posterior-superior repositioning of the maxilla. The patients were 3 males （7％） and 41 females （93％）. 2．The mean age at surgery was 27.3 at s years old （range: 16-60 years）. 3．The most common clinical diagnosis was maxillary prognathism with maxillary excess （16 cases: 36.4％）. 4．The most common surgical method was Le Fort Ⅰ osteotomy （LF Ⅰ+SSRO （23 cases: 52.3％））, followed by LF Ⅰ+SSRO+Genioplasty （GEN） （11 cases: 25.0％）. 5．The average time of operation for LF Ⅰ+SSRO was 306.7±56.2 minutes and that for LF Ⅰ+SSRO+GEN was 337.1±59.1 minutes. 6．The average amount of bleeding was 461.7±188.0ml for LF Ⅰ+SSRO and that for LF Ⅰ+SSRO+GEN was 377.0±206.0ml. 7．The average distance of posterior and superior of the maxilla was 3.6±1.6mm and 4.3±2.1mm, respectively.
The Japanese Society for Jaw Deformities performed a nationwide survey from 2006 to 2007 and the results were reported in 2008. In the last 10 years, new surgical procedures and medical devices have been developed and brought major changes to surgical orthodontic treatment. Accordingly, we need to assess the current status of surgical orthodontic treatment. A nationwide survey of surgical orthodontic treatment between April 2017 and March 2018 was carried out and 99 surgical facilities and 64 orthodontic facilities were enrolled in the survey. The number of patients who received orthognathic surgery was 3,405, about 69％ of whom were diagnosed with mandibular protrusion. Before the surgery, 3D-simulation was performed for about 40％ of patients at both surgical and orthodontic facilities. Computer-aided design and computer-aided manufacturing （CAD/CAM） wafers were used at 12.1％ of surgical facilities and at 17.7％ of orthodontic facilities. Sagittal split ramus osteotomy （SSRO） was performed in 2,768 patients （85.5％） and Le FortⅠosteotomy in 1,829 patients （56.5％）. Blood loss during the surgery was reduced compared with that in the previous survey. Autologous blood transfusion tended to be performed in cases as necessary such as surgery for maxilla and anemia of the patient. Duration of intermaxillary fixation and hospital stay were also shortened. This survey revealed the current status of surgical orthodontic treatment in Japan in comparison with the previous survey.
The patient was a 51-year-old female who came to the hospital because of poor retention of the upper complete denture and mandibular protrusion. The oral condition was maxillary edentulous and mandibular bilateral free-end edentulous. Based on facial findings, examination of the oral cavity, panoramic radiograph, and frontal and lateral cephalogram findings, the patient was diagnosed with skeletal mandibular prognathism. For this patient, a temporary transparent denture was made by duplicating the used complete denture. A precision impression was taken with a duplicate denture, and a new complete denture was made at a position where the mandible was moved three-dimensionally according to the amount of mandibular set-back predicted from the cephalometric trace. Later, bilateral mandibular sagittal split ramus osteotomy was performed as orthognathic surgery. The multidisciplinary approach provided the skeletal corrections of SNA, SNB and ANB as 81.8°, 81.7° and 0.1°,
respectively, and also excellent facial appearance after treatment. It is suggested that preoperative cephalometric prediction, simulated by the correct postoperative mandibular position and appropriate incisal inclination, can provide valuable information for the orthognathic treatment of edentulous skeletal Class Ⅲ patients.