Significant Premaxillary Augmentation

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction

“…The degree of divergence from this ideal profile corresponds to the severity of recession. 1 In this regard, the intended outcome following premaxillary augmentation is reduction of the facial convexity angle toward zero or the ideal angle (-12 AE 4 degrees). 1,7,8 The amount of augmentation needed to achieve this has been described to correspond to approximately double the anterior soft tissue movement required, with a 0.5:1 soft-to-hard tissue ratio cited in maxillary advancement.…”

“…Anatomically, the premaxilla consists of the osseous segment between the two maxillary incisor fissures. 1 Hypoplasia of this bony segment results in significantly decreased premaxillary projection. Although characteristically observed in patients with cleft lip and palate deformities, this deformity may be seen in otherwise healthy individuals within Asian or African American communities.…”

“…2 The lack of underlying structural support results in retraction of the nasal base at the columella resulting in an acute nasolabial angle, relatively elongated upper cutaneous lip, tip ptosis, and labial incompetence. 1,3 Patients may present with isolated premaxillary deficiency seeking aesthetic refinement of these deformities. The reconstructive surgeon must, however, appropriately identify patients with concomitant findings indicative of malocclusion.…”

“…Individuals with class III occlusion, in which the mandibular first molar is located anteriorly in relation to the mesiobuccal cusp of the maxillary first molar, will require orthognathic intervention. 1,4 In patients without malocclusion, and with adequate bone stock, premaxillary augmentation is the mainstay of treatment. A multitude of techniques have been described within the primary literature describing correction of the acute nasolabial angle and underlying premaxillary retrusion.…”

Midface Augmentation Using Bony Segments Obtained from Sagittal Splitting Angle Ostectomy in Asians

“…Their implant, although addressing the central deficiency, did not address the lateral recessions. This problem was addressed by Cook et al, 14 who described the use of a wider Proplast implant. Although they recorded good success with their implant, the Proplast material may be more difficult to shape and is more expensive than its Silastic (Dow Corning Corp., Midland, Mich.) counterpart.…”