Patient may require surgery which involves the maxilla (top jaw). Individuals can have too much growth in the top jaw and end up with a gummy smile (vertical maxillary excess). This requires surgery in the maxilla which removes the excess bone and the jaw is then placed at a higher level. Patients with anterior open bites (apertognathia) may require surgery to correct this by placing the posterior aspect of the upper jaw higher. This surgery is called a Lefort Osteotomy.
Patients may have an upper jaw which is too small. The maxilla may develop which is too narrow. During growth and development the bones can be widened with an appliance without surgery. However, following adolescence it is necessary to open the growth plates through surgery. The bones are then widened with a similar appliance. Through the technique of distraction osteogenesis the new bone is deposited while the bones are spread apart. This surgery is called a Surgical Assisted Rapid Palatal Expansion.