Assessment of Pterygomaxillary Separation in Le Fort I Osteotomy in Class III Patients

Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Okabe, Katsuhiko; Alam, Shamiul; Nakagawa, Kiyomasa; Yamamoto, Etsuhide

doi:10.1016/j.joms.2008.11.019

Cited by 33 publications

(11 citation statements)

References 26 publications

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“…The results presented differences of 1.66 and 2.54 mm from the physical measurement and a moderate correlation coefficient in interexaminer analysis, which can compromise the surgical result. In agreement to our results, Ueki et al 11 stated that the measurement position affects the measurement thickness of the ptergomaxillary region, suggesting that it could induce unexpected fractures of the pterygomaxillary region. We believe that these difficulties arose because the linear measurements using OsiriX software were obtained only over a single view of the 3D reconstructed image, and all the measurements whose points require different translation and rotation to be identified, such as those involved in the pterygoid process, could not be easily identified and were therefore not considered to be sufficient for Le Fort I osteotomy pre-operative planning.…”

Section: -17supporting

confidence: 93%

“…Most of the bone structures were selected specifically for the study instead of using traditional craniometrical points, insofar as analysis of these structures is highly relevant for planning Le Fort I osteotomy (Table 1). [10][11][12] The examiners analysed all volumes scanned using axial and MPR images and pointed to the first landmark of the anatomical structure using an arrow or a circle for both tested software programs. This first landmark was performed on the MPR and automatically transferred to the 3D reconstructed image.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of precision and accuracy of linear measurements performed by two different imaging software programs and obtained from 3D-CBCT images for Le Fort I osteotomy

Gaia

Pinheiro²,

Umetsubo³

et al. 2013

Dentomaxillofacial Radiology

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Objective: The purpose of this study was to compare the precision and accuracy of linear measurements for Le Fort I osteotomy performed by two different imaging software programs and obtained from three-dimensional cone beam CT (3D-CBCT) images. Methods: The study population consisted of 11 dried skulls submitted to CBCT, which generated 3D images. Linear measurements were based on craniometric anatomical landmarks pre-defined by the authors as specifically used for Le Fort I osteotomy and were identified by two radiologists twice each, independently, using Vitrea 3.8.1 (Vital Images Inc., Plymouth, MN) and open-source digital imaging communication in medicine viewer OsiriX 1.2 64-bit (Pixmeo, Geneva, Switzerland). Subsequently, a third examiner made physical measurements using a digital caliper (167 series; Mitutoyo Sul Americana Ltd, Suzano, SP, Brazil). Results: The results demonstrated a statistically significant difference between OsiriX and the gold standard, especially in the pterygoid process (TPtg L 5 0.019, LLpPtg R 5 0.016 and LLpPtg L 5 0.012). Vitrea showed no statistical difference in comparison with the gold standard, and showed a high level of accuracy in all the measurements performed. The major difference found was 0.42 mm (LLpPtg R). Interexaminer analysis ranged from 0.90 to 0.97 using Vitrea and from 0.8 to 0.97 using OsiriX. Intraexaminer correlation coefficient ranged from 0.90 to 0.98 and from 0.84 to 0.98 for Examiners 1 and 2, respectively, using Vitrea and from 0.93 to 0.99 for Examiner 1 and from 0.64 to 0.96 for Examiner 2 using OsiriX. Conclusion: Vitrea may be considered as precise and accurate, insofar as it was able to perform all the 3D linear measurements. On the other hand, linear measurements performed using OsiriX were not successful in producing accurate linear measurements for Le Fort I osteotomy.

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Section: -17supporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Comparison of precision and accuracy of linear measurements performed by two different imaging software programs and obtained from 3D-CBCT images for Le Fort I osteotomy

Gaia

Pinheiro²,

Umetsubo³

et al. 2013

Dentomaxillofacial Radiology

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“…In 29 of 74 sides (39.2%), complete separation between the maxillary tuberosity and the lateral and/or medial pterygoid plate did not occur at the pterygomaxillary junction at the posterior nasal spine level. However, exact separation occurred more frequently at the lower level, with no complications (Ueki et al, 2009a).…”

Section: Discussionmentioning

confidence: 89%

Assessment of bone healing after Le Fort I osteotomy with 3-dimensional computed tomography

Ueki

Miyazaki

Okabe

et al. 2011

Journal of Cranio-Maxillofacial Surgery

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Key words:Bone healing, Pterygoid plate, Le Fort I osteotomy, ultrasonic bone curette, 3-demensional computed tomography (3DCT) AbstractPurpose. The purpose of this study was to examine bone healing after Le Fort I osteotomy in Class III patients.Patients and Methods. The study group consisted of 18 Japanese patients with mandibular prognathism with and without asymmetry, maxillary retrognathism or open bite. A total of 36 sides were examined. Le Fort I osteotomy was performed without a pterygoid osteotome, with an ultrasonic curette used to remove interference at the pterygomaxillary region. Titanium plates (Universal Mid-face fixation module, Stryker, Freiburg, German)were used for four patients, absorbable plates (poly-L-lactic acid (PLLA): NEOFIX®, Gunze, kyoto, Japan) were used for four patients and other absorbable plates (uncalcined and unsintered hydroxyapatite and poly-L-lactic acid (uHA/PLLA): super FIXSORB®MX, Takiron Co. Ltd, Osaka, Japan) were used for ten patients, in the same manner.Postoperative computed tomography (CT) was analyzed for all patients pre-operatively and 1 year post-operative. The anterior and lateral areas between the maxillary segments were measured with 3-dimensional (3D) CT. Bone healing at the pterygomaxillary region was also assessed.Results. There were no significant differences in the area of bone defect healing among the plate types. The areas of bone defect after 1 year were significantly smaller than that immediately after surgery on the right side (p=0.0145) and left side (p=0.0010) in the frontal view and right side in the lateral view (p=0.0118). Bone healing at the pterygo-maxillary junction was found in all cases without artificial pterygoid plate fracture.14 of 22 sides with artificial pterygoid plate fracture by an ultrasonic curette showed bone continuity between the pterygoid plate and posterior part of maxilla.Conclusion. This study suggested that bony healing could occur in spaces between the segments of maxilla and pterygomaxillary regions as well as the region of the anterior and lateral walls in the maxilla, but it is not always complete within 1 year after Le Fort I osteotomy.

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“…More the height more the risk of pterygoid plate fractures but our study did not show any correlation with this finding. Most of the studies related to pterygomaxillary region are either done on dry skulls [21,22] or done on Korean or Japanese population [1,23,24]. In our study, we have made an attempt to determine the dimensions of pterygomaxillary region in South Indian population.…”

Section: Discussionmentioning

confidence: 99%

“…The junction where the tuberosity of the maxilla and the anterior part of the pterygoid plates meet is referred to as pterygomaxillary junction. During Le Fort I osteotomy, we may not achieve the exact separation of this junction [1]. Anatomical variations in this region such as abnormally thick posterior wall of the maxilla or bony defects can lead to unfavorable pterygomaxillary dysjunction [2].…”

Section: Introductionmentioning

confidence: 99%

Preoperative and Postoperative CT Scan Assessment of Pterygomaxillary Junction in Patients Undergoing Le Fort I Osteotomy: Comparison of Pterygomaxillary Dysjunction Technique and Trimble Technique—A Pilot Study

Dadwal¹,

Shanmugasundaram

Raja

2014

J. Maxillofac. Oral Surg.

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Purpose To determine the rate of complications and occurrence of pterygoid plate fractures comparing two techniques of Le Fort I osteotomy i.e., Classic Pterygomaxillary Dysjunction technique and Trimble technique and to know whether the dimensions of pterygomaxillary junction [determined preoperatively by computed tomography (CT) scan] have any influence on pterygomaxillary separation achieved during surgery. Materials and methods The study group consisted of eight South Indian patients with maxillary excess. A total of 16 sides were examined by CT. Preoperative CT was analyzed for all the patients. The thickness and width of the pterygomaxillary junction and the distance of the greater palatine canal from the pterygomaxillary junction was noted. Pterygomaxillary dysjunction was achieved by two techniques, the classic pterygomaxillary dysjunction technique (Group I) and Trimble technique (Group II). Patients were selected randomly and equally for both the techniques. Dysjunction was analyzed by postoperative CT. Results The average thickness of the pterygomaxillary junction on 16 sides was 4.5 ± 1.2 mm. Untoward pterygoid plate fractures occurred in Group I in 3 sides out of 8. InTrimble technique (Group II), no pterygoid plate fractures were noted. The average width of the pterygomaxillary junction was 7.8 ± 1.5 mm, distance of the greater palatine canal from pterygomaxillary junction was 7.4 ± 1.6 mm and the length of fusion of pterygomaxillary junction was 8.0 ± 1.9 mm. Discussion The Le Fort I osteotomy has become a standard procedure for correcting various dentofacial deformities. In an attempt to make Le Fort I osteotomy safer and avoid the problems associated with sectioning with an osteotome between the maxillary tuberosity and the pterygoid plates, Trimble suggested sectioning across the posterior aspect of the maxillary tuberosity itself. In our study, comparison between the classic pterygomaxillary dysjunction technique and the Trimble technique was made by using postoperative CT scan. It was found that unfavorable pterygoid plate fractures occurred only in dysjunction group and not in Trimble technique group. Preoperative CT scan assessment was done for all the patients to determine the dimension of the pterygomaxillary region. Preoperative CT scan proved to be helpful in not only determining the dimensions of the pterygomaxillary region but we also found out that thickness of the pterygomaxillary junction was an important parameter which may influence the separation at the pterygomaxillary region. Conclusion No untoward fractures of the pterygoid plates were seen in Trimble technique (Group II) which makes it a safer technique than classic dysjunction technique. It was noted that pterygoid plate fractures occurred in patients in whom the thickness of the pterygomaxillary junction was \3.6 mm (preoperatively). Therefore, preoperative evaluation is important, on the basis of which we can decide upon the technique to be selected for safer and acceptable separation of pterygomaxillary region.

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Assessment of Pterygomaxillary Separation in Le Fort I Osteotomy in Class III Patients

Cited by 33 publications

References 26 publications

Comparison of precision and accuracy of linear measurements performed by two different imaging software programs and obtained from 3D-CBCT images for Le Fort I osteotomy

Comparison of precision and accuracy of linear measurements performed by two different imaging software programs and obtained from 3D-CBCT images for Le Fort I osteotomy

Assessment of bone healing after Le Fort I osteotomy with 3-dimensional computed tomography

Preoperative and Postoperative CT Scan Assessment of Pterygomaxillary Junction in Patients Undergoing Le Fort I Osteotomy: Comparison of Pterygomaxillary Dysjunction Technique and Trimble Technique—A Pilot Study

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