Factors predictive of pterygoid process fractures after pterygomaxillary separation without using an osteotome in Le Fort I osteotomy

Kanazawa, Teruyuki; Kuroyanagi, Norio; Miyachi, Hitoshi; Ochiai, Shigeki; Kamiya, Noboru; Nagao, Toru; Shimozato, Kazuo

doi:10.1016/j.oooo.2012.04.020

Cited by 33 publications

(29 citation statements)

References 30 publications

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“…Factors like improper angulation of the osteotome, blunt chisel, forceful downfracturing of the maxilla, poor access and visibility and surgeon's experience are the other factors responsible for unfavorable pterygoid plate fractures. Additionally, male gender along with increased age can be significant risk factors for unfavorable pterygoid plate fractures [29]. Most of our patients were below 25 years of age, and we had only 3 male patients, therefore, it is difficult to correlate factors like increased age and male gender with our present study.…”

Section: Discussionmentioning

confidence: 83%

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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Section: Discussionmentioning

confidence: 83%

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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“…Von Langenbeck first described osteotomy of the Le Fort I level for the removal of nasopharyngeal polyps in 1859. In 1901, French physician Rene Le Fort [5] described the most common classification of such osteotomies. He analyzed the patterns of maxillofacial fractures.…”

mentioning

confidence: 99%

“…The dimension of thickness and length of the pterygomaxillary junction have significant influence on the success of its separation. An increased thickness of the pterygomaxillary junction predisposes it to fractures at the greater palatine foramen [5,9]. On the other side one of the potential risk factors for pterygoid plate fracture is a thin and short pterygomaxillary junction [5].…”

mentioning

confidence: 99%

“…An increased thickness of the pterygomaxillary junction predisposes it to fractures at the greater palatine foramen [5,9]. On the other side one of the potential risk factors for pterygoid plate fracture is a thin and short pterygomaxillary junction [5]. While performing pterygomaxillary dysjunction, the surgeon can use a handle maneuver, osteotome or oscillating saw.…”

mentioning

confidence: 99%

“…In patients with a greater thickness of the pterygoid plates, there is an expected dysjunction of the pterygoid plate from the maxillary tuberosity. Such separation is possible to achieve with osteotomy through maxillary tuberosity [5]. This explains why awareness of an individual patient's anatomy is so important before surgery.…”

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confidence: 99%

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Reproducibility of Linear Measurements Performed with 3-D Cone Beam Computed Tomography: Scan Reconstructions in Region of Pterygomaxillary Junction

Jędrzejewski¹,

Smektała²,

Sporniak‐Tutak³

et al. 2016

Dent. Med. Probl.

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Background. Pterygomaxillary dysjunction is the most dangerous part of Le Fort I osteotomy. Preoperative evaluation of the patient's anatomy in 3D imaging software may help to choose an appropriate surgical approach and minimize the risk of the operation. Objectives. The aim of this study was to evaluate the reproducibility of linear measurements performed at the pterygomaxillary junction using open source software. Material and Methods. The study population consisted of 101 patients who underwent a CBCT examination for reasons independent of this study. Eight anatomical landmarks in the pterygomaxillary junction were pre-defined to measure the thickness and length of this structure. Linear measurements between the landmarks were performed in duplicate by two independent observers over 14 days. The data was evaluated using Netfabb Basic Studio (Netfabb Company, Parsberg, Germany). An analysis of variance (ANOVA) studied the influence of certain factors (side, observer, and repetition) on the accuracy of the measurements. Results. The mean value of all the valid measurements was 2.76 mm for thickness and 16.71 mm for the length of the pterygomaxillary junction. ANOVA showed no inter-observer bias. None of the observers reported statistically significantly higher or lower values than the other observer (p > 0.05). The intra-observer reproducibility was better than the inter-observer reproducibility of the measurements. The intra-and inter-observer reproducibility analyzed for log-transformed absolute values of differences between the measurements was very good (< 0.5 mm mean difference for linear values reconstructed from the log). The results were from a relatively large population and offered useful and reproducible measurements using open source software during the planning of orthognathic procedures. Conclusions. The results confirmed the reproducibility of the measurements. This method may be used during the diagnostics and planning of Le Fort I osteotomy. We also propose further evaluation of open-source software programs. Their comparison may help standardize the planning of orthognathic procedures (Dent. Med. Probl. 2016, 53, 3, 320-331).

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Cleft Maxillary Hypoplasia

Mathew

Mustafa

Mathai

2021

Oral and Maxillofacial Surgery for the Clinician

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Cleft lip and palate patients are born with a challenging deformity that requires multiple surgical interventions in order to reach functional and esthetic harmony. Mid face deficiency in cleft patients is a challenging clinical problem very often encountered in the management of this congenital defect. Cleft maxillary hypoplasia can be attributed to the inherited traits, acquired traits and Induced traits. CLP patients usually present with symptoms varying from malocclusion, retrusion of midface, and a narrow hard palate. A detailed evaluation and individualized treatment planning is of utmost importance in dealing with these patients. Treatment involves the contribution from both the orthodontist and the craniofacial team. The goals for the treatment for cleft maxillary hypoplasia are improvement of aesthetic deficits as well as correction of malocclusion.

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Factors predictive of pterygoid process fractures after pterygomaxillary separation without using an osteotome in Le Fort I osteotomy

Cited by 33 publications

References 30 publications

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

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

Reproducibility of Linear Measurements Performed with 3-D Cone Beam Computed Tomography: Scan Reconstructions in Region of Pterygomaxillary Junction

Cleft Maxillary Hypoplasia

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