The ‘Downsliding’ Osteotomy; Highlighting an under-used Surgical Technique to Manage Vertical Maxillary Deficiency

Vertical ‘down grafting’ of the maxilla is routinely performed using orthotopic bone graft or heterotopic donor bone products. It is well documented that with this approach, bone grafting does not always result in a favorable stable outcome as relapse commences before complete integration of the graft. We wish to highlight the ‘down sliding’ osteotomy, first described by Reynekein 1985, which allows anterior and inferior movement of the maxilla after a ‘z’shaped Le Fort 1 osteotomy is performed. Bony contact is preserved at themedial pyriform and lateral maxillary buttresses as the maxilla displaces downa sloping plane, thereby obviating the need for bone grafting. We demonstratehow to decide whether a patient is suitable for this technique by utilizingVisual Treatment Objective Schematics prior to the commencement of pre-surgical orthodontics.The ‘down sliding’ osteotomy is straightforward and reliable technique. Itavoids the necessity of a donor surgical site, thereby minimizing operatingtime and hospital stay. We believe that the ‘down sliding’ osteotomy is ahighly cost-effective yet under-used surgical technique which should becontemplated for suitable cases. References1. Wagner S, Reyneke JP. The Le Fort I downsliding osteotomy: a studyof long-term hard tissue stability. Int J Adult Orthodon Orthognath Surg.2000; 15 (1): 37-492. ReynekeJP, Masureik CJ. Treatment of maxillary deficiency by a LeFort 1 downsliding technique. J Oral Maxillofac Surg. 1985; 43 (11):914-6