Although Le Fort I osteotomy is performed to correct vertical maxillary alveolar excess (VMAE) in patients with a gummy smile and high palate, this procedure carries the risk of nasal cavity constriction. A combined Le Fort I and horseshoe osteotomy is complicated. On the other hand, although total maxillary alveolar osteotomy (TMAO) , which was reported by Wolford and Hall, can improve VMAE without causing nasal cavity constriction, correctly performing one-stage osteotomy is very difficult

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... ause of difficulty in obtaining a sufficient surgical field with maintenance of the blood supply. Therefore, we have devised a two-stage procedure for TMAO. In this procedure, osteotomy of the palatine bone is performed initially, followed by another osteotomy of the buccal side after wound healing. In this study, the accuracy of superior repositioning and the postoperative stability of the maxilla obtained by two-stage TMAO in patients with a gummy smile were found to be excellent. Therefore, we consider two-stage TMAO to be an effective procedure for correcting a gummy smile accompanied by VMAE. : total maxillary alveolar osteotomy (上顎全歯槽骨切り術) , gummy smile (ガミースマイル) , postoperative stability (術後安定性) 1) 国家公務員共済組合連合会呉共済病院歯科口腔外科 (主任:東森秀年部長) 2) 高松歯科口腔外科クリニック (主任:三次正春手術顧問) 3) 広島大学大学院医歯薬保健学研究院応用生命科学部門口 腔外科学 (主任:武知正晃准教授) 1)