Following the desimpaction of the m

Following the desimpaction of the maxilla, a septoplasty and reduction of the inferior turbinates may be performed when indicated. If segmentation of the maxilla is planed the interdental cuts will be completed at this stage as well as parasagittal osteotomies through the hard palate. Next the maxilla is placed into final occlusion by means of a prefabricated final splint and the jaws are wired together with 0.4 or 0.5 mm surgical steel wire-loops. With the condyles seated in the terminal hinge position, the maxillomandibular complex is rotated to achieve the vertical dimension that was planned preoperatively. For this purpose the distance between the Kirschner wire in the glabella area and the mid-maxillary incisor crown is checked by means of a calliper set in the planned vertical movement of the mid-maxillary incisor tip. If vertical shortening (impaction) of the maxilla is planned, this will require removal of bony interferences with a straight dental surgical bur and a piezoelectric surgical device. Attention should also be paid to the possible indication for bone removal at the region of the anterior nasal spine, the nasal aperture and the floor of the nose.