[Evolution of maxillo-malar osteotomy. Clinical experience]

Zygomaticomaxillary osteotomy is indicated in patients who have midfacial deficiency, a class III skeletal malocclusion and normal nasal projection. Many surgical procedures using an intraoral and an extraoral approach of the intraoral approach alone have been described. We prefer the intraoral approach because of the good aesthetic and functional results and the very low incidence of operative and postsurgical complications. As an alternative to these methods some authors have proposed a Le Fort I osteotomy associated with bone or alloplastic grafts in the malar region and a "high" Le Fort I osteotomy called quadrangular Le Fort I osteotomy. These techniques envisage total mobilization of the maxilla including the infraorbital rim. In our experience patients who have a scleral-show can undergo an osteotomy with infraorbital rim mobilization; patients who don't need a protection of the inferior sclera, instead, are advantageously treated without mobilizing the intraorbital rim. We illustrate our experience by reporting two out of 48 patients operated on using the intraoral approach.