AB195. SOH24AB_194. The utility of a four-piece segmental maxillary osteotomy in the correction of a traumatic anterior open-bite

Background: Anterior open-bite (AOB) refers to a type of malocclusion in which is there no overlap of anterior teeth when teeth are guided into maximum-intercuspation. AOBs can result in both aesthetic and functional concerns for the patient. The aetiology of these malocclusions are multi-factorial and result from genetic, habitual and/or environmental factors, including trauma to the mid-face. Some AOBs can be managed orthodontically, however in some cases, the malocclusion can be so severe that surgical rectification may be the only option for correction.

Methods: Herein, we present a 44-year-old who developed an AOB as a result of a kick to the face by a horse.

Results: Resulting from the trauma, the patient sustained a combination Le-Fort fracture of the mid-face and a highly comminuted fracture of the anterior maxilla which was initially treated with intermaxillary-fixation screws and elastics. This trauma resulted in the development of an AOB which was incapable of being treated with orthodontics alone. After discussion with the orthodontist and with the use of virtual planning, a four-piece segmental maxillary osteotomy was chosen to correct the malocclusion due to the grossly misshapen maxilla as a result of the trauma.

Conclusions: Four-piece segmental maxillary osteotomies are a valid treatment option for the correction of AOBs that cannot be rectified with orthodontics alone. Multiple techniques have been mentioned in the literature for carrying out maxillary segmental osteotomies, including two-piece, three-piece and four-piece osteotomies. When compared to other segmental osteotomy techniques, research has shown that four-piece osteotomies are easier in technique and have decreased post-operative complications such as incidence of oro-nasal fistulas.

Keywords: Anterior open-bite; Le Fort fracture; maxillary segmental osteotomy; virtual planning; trauma