Maxillary and Midface Deficiency
Patients with maxillary deficiency commonly appearto have a retruded upper lip, deficiency of the paranasal and infraorbital rim areas, inadequate tooth exposure during smile, and a prominent chin relative to the middle third
of the face.’ Maxillary deficiency may occur in the antero-
is frequently seen.The primary technique for correction of maxillary
deficiency is the Le Fort I osteotomy. This technique can be used for advancement of the maxilla to correct a class III malocclusion and associakd facial abnormalities (fig. 25·24 on .pages 586 and 587). Depending on the magrutude of advancement, bone grafting may be required to improve bone healing and postoperative stability. In the
case of vertical maxillary deficiency, elongation of the IUI\’et third of the face can he accomplished by bone grafting the maxilla in an inferior position with the Le Fort I osteotomy technique (I·ig. 25·25 on page 588). This technique improves overall facial proportion and normalizes
exposure of the incisors during smiling. In severe midface deformities with infraorbital rim and malar eminence deficiency, a l.e Fort III or modified Le Fort III type of osteotomy h necessary. These procedures advance the maxilla and the malar bones and, in some cases, the anterior portion of the nasal bones. This type of treatment is commonly required in patients with craniofacial deformities such as Aport’s or Ciouzori’s syndrome (Fig. 25-26·on page 5H9).