Investigation of Two-Stage Total Maxillary Alveolar Osteotomy for Superior Repositioning of the Maxilla in Patients with a Gummy Smile Accompanied by a High Palate

Although Le Fort I osteotomy is performed to correct vertical maxillary alveolar excess (VMAE) in patients with a gummy smile and high palate, this procedure carries the risk of nasal cavity constriction. A combined Le Fort I and horseshoe osteotomy is complicated. On the other hand, although total maxillary alveolar osteotomy (TMAO), which was reported by Wolford and Hall, can improve VMAE without causing nasal cavity constriction, correctly performing one-stage osteotomy is very difficult because of difficulty in obtaining a sufficient surgical field with maintenance of the blood supply.