Palatal Approach to the Anterior Maxillary Sandwich Osteotomy

Purpose: This report describes a technique used to increase vertical height and anterior prominence of the anterior maxilla. Patients and Methods: Two cases illustrate the palatal approach to segmental osteotomy with interpositional bone grafting (sandwich osteotomy) of the anterior maxilla. The palatal approach allows the segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the tight palatal tissue creates a vector of force toward the palate. The vascular pedicle for the segmental bone flap using the palatal approach is the labial mucosa and musculature. Results: The maxillary alveolar ridge in case 1 was advanced 4 mm anteriorly and 5 mm inferiorly. In case 2, the ridge was moved 4 mm anteriorly and 6 mm inferiorly. Cases 1 and 2 were later successfully restored with dental implants. Conclusion: The palatal approach to the anterior maxillary osteotomy was found to be effective in 2 cases that required anterior and inferior repositioning of the anterior maxilla. (C) 2013 American Association of Oral and Maxillofacial Surgeons