Many cases with facial asymmetry have sagittal and vertical problems in the maxilla as well as in the mandible. Unilateral superior movement of the maxilla is frequently planned to correct the vertical problem after Le Fort Ⅰ osteotomy. In cases with underdevelopment in the maxillary vertical height, it is difficult to obtain facial and occlusal correction by such movement. However, the postoperative stability of the unilateral maxillary inferior movement is poor. Thus, we took advantage of using a titanium mesh plate for bone fixation, and performed unilateral maxillary inferior movement after Le Fort Ⅰ osteotomy in two cases.
Case 1: An 18-year-old male with the chief compliant of right facial deviation. His occlusal plane was inclined superiorly to the right. After Le Fort Ⅰ osteotomy, the maxilla was moved inferiorly in the right by 1.7mm, and superiorly in the left by 2.3mm. Inverted L-shaped ramus osteotomy and SSRO were performed in the left and right sides of the mandible, respectively.
Case 2: A 31-year-old male with the chief compliant of left facial deviation. His occlusal plane was inclined superiorly to the left. After Le Fort Ⅰ osteotomy, the maxilla was moved inferiorly in the left by 4.5mm, and superiorly in the right by 2.5mm. SSRO and IVRO were performed in the left and right sides of the mandible, respectively. In both cases, maxillary segments were rigidly fixed at the lateral border of the pyriform and the inferior border of the zygoma with 0.4mm-thick titanium mesh plates and 0.7mm-thick titanium L-shaped plates using 6.0mm-long titanium screws. Interpositional bone graft was not performed between the maxillary segments in both cases. After operation, the maxillary height of the deviated sides was increased, and the inclination of the occlusal planes was improved. Sufficient postoperative stability and facial symmetry were obtained in both cases.