Premaxilla: an independent bone that can base therapeutics for middle third growth!

Abstract

Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

Septopremaxillary ligament traction system: a review

“…The tissue separating force emanating from the expanding nasal septum is being transmitted to the premaxilla through the septopremaxillary ligament. 5,6,9,[26][27][28] The influential role of cartilaginous nasal septum as the pacemaker of growth has received considerable attention in the literature. But the result of the experimental studies in laboratory animals has not led to universal results.…”

“…10,16,22 The transmission of the growth force is of mechanical in nature 34 and the SPL, an apparently key structure, acts as a bridge of soft tissue between the nasal septum and the premaxilla. 5,6,26,27…”

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

“…The anatomy of the premaxillary area has not been fully described 17 . The time in its growth and development when the suture between the premaxilla and the maxilla fuses, so that they become a single bone, has not been determined 18 . Abnormal growth in this region may be correlated with malformations, such as prognathism, deep bite and protrusion 12 …”

“…Treatment follows several stages, such as alveolar bone grafting, with a graft that may be autogenous or synthetically manufactured 22 and is used to fix the cleft. The existence of a premaxilla as an independent bone makes it possible to move it 18 to reduce the cleft before grafting and to place it at a more favorable position.…”

“…Orthodontic appliances may lead the premaxilla to a more beneficial anterior position 23 , 14 by stimulating the maxillary sutures 23 . The stimulation of the premaxillary-maxillary suture results in the development of this region 18 , 23 - 25 by means of inflammation and repair that culminates in remodeling the maxillary complex, 26 which may be used for the non-surgical protraction of the maxillary complex following, for example, the Ertty Gap III ® protocol 27 . Therefore, the suture between the premaxilla and the maxilla may be the adequate biomechanical point for interventions in cases of Class III malocclusion, in which the diagnosis indicates insufficient maxillary complex development.…”