Understanding maxilo-facial orthopaedics has become the foundation for modern orthodontics. Over eighty five percent of all patients have some type of maxillary deficiency.This deficiency may express itself as a transverse problem, it can be seen in an anterior – posterior direction, resulting in a short maxilla; and it can be seen in a retrognathic position of the maxilla relative to the anterior cranial base.These deficiencies can also occur in any combination.

When the maxilla is under developed in any of these three planes, there is a negative effect on the patient’s facial growth and dentition.For example, a transverse deficiency (narrow arch) not only creates dental crowding, but also traps the mandible preventing normal forward and downward growth.Some types of maxillary entrapment can always be seen in the skeletal class II patient.

In addition to affecting the growth of the patient, maxillary entrapment upon the mandible can force the mandibular condyles distally within the glenoid fossa.This distal position of the condyle relative to the meniscus is the primary cause of temporal-mandibular dysfunction.

The symptoms may include pain within the joint, tinnitus, vertigo, difficulty in opening and closing the mouth, and a wide variety of head and neck pain.

The maxilla also has a direct effect on the function of the respiratory system.When the maxilla is narrow, the palatal vault will be high.This in turn causes the nasal passage to be constricted both transversely and vertically.The patient is forced to mouth breath creating a severe vertical growth pattern with the face.Other respiratory effects include chronic inflammation of the tonsil and adenoid tissue and middle ear infections due to reflux within the Eustachian tube.Many children who have had tubes placed in their ears on a regular basis return to normal function by simply developing the size of the maxilla.

The most obvious clinical effect of an under-development of the maxilla is the change that occurs in the facial profile.The severe skeletal class II patient that presents as a “chinless wonder” can easily be corrected after the maxilla is properly developed.

Certainly the orthodontic component of any malocclusion must be addressed with fixed appliance therapy.This phase of the treatment usually follows the completion of the maxilo-facial orthopaedic therapy.Most fixed orthodontic treatments are now twelve months or less.

A large majority of the patients can be treated on a non-extraction basis.

Treatment of a structural nature is often far easier than you may think, as you will discover should you decide to invest in your future and attend a forthcoming course I, the first in a series of six courses which are designed to take you from the very basics, right through to the most complex of cases.

Our objectives should be to create beautiful smiles, pleasing facial aesthetics, healthy temporal-mandibular joints and an occlusion that will last a lifetime. 

Dr J. W. Truitt, B.S., D.D.S.