Controversy continues about the cause and effect of airway obstruction on facial growth. We do know vertical maxillary excess (a "gummy smile") generally occurs in the presence of blocked nasal airflow and a mouth-breathing (respiratory) habit that is ongoing during childhood when the facial bones are developing.

In this situation, the facial skeleton grows long (vertically) and the appearance demonstrates increased length to the upper jaw "gummy smile" with a large separation (distance) between the upper and lower lips, a deficient (small) lower jaw and a long and retruded chin.

A thoughtful facial aesthetic examination, by an experienced surgeon combined with effective preoperative orthodontic treatment, dental model analysis, and meticulous surgical technique will result in improved facial appearance; chewing ability, speech articulation, nasal air flow, and lip closure.

Example (figure 5).

Example (figure 6).