Is an osteotome necessary for pterygomaxillary dysjunction or dysjunction through the tuberosity during Le Fort I osteotomy? A systematic review

Breeze, John; Linares, C. Verea; Stockton, Peter

doi:10.1016/j.bjoms.2015.11.014

Cited by 26 publications

(10 citation statements)

References 42 publications

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“…In the present case, an ultrasonic device was also used to perform procedures in the pterygomaxillary area to safely mobilize the pterygoid process, and the postoperative bleeding was not from this area. Recently, a large clinical trial for down fracture in Le Fort I osteotomy by digital pressure alone showed no severe complications [9]. Moreover, there are no strong evidences of the usefulness of osteotomes in pterygomaxillary disjunction or disjunction via the maxillary tuberosity [9].…”

Section: Discussionmentioning

confidence: 99%

Delayed Epistaxis which Was Developed after Orthognathic Surgery with Le Fort I Osteotomy and Managed by Endoscopic Cauterization

Kurasawa

Sato

Katada

et al. 2022

Case Reports in Dentistry

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A case of delayed epistaxis from the mucosa behind the right side of the inferior nasal mucosa 11 days after orthognathic surgery by Le Fort I osteotomy is presented. The patient was a 31-year-old man who underwent orthognathic surgery under general anesthesia. No abnormal findings were found during or after the operation. The patient was discharged from the hospital 10 days postoperatively. However, bleeding from the right nasal cavity occurred suddenly on the night after discharge, and he presented to our hospital again. The epistaxis was stopped once by nasal packing containing 0.001% epinephrine and systemic infusion of carbazochrome sulfonic acid and tranexamic acid. However, when the nasal packing was removed the next day, right nasal epistaxis was observed again. Curvature of the nasal septum and thickening of the inferior turbinate mucosa were seen on inspection; although, no active bleeding point was identified. Decreased nasal mucosa thickening and bleeding were observed after nasal packing containing 0.02% epinephrine. When the inside of the nasal cavity was observed endoscopically, an approximately 2 mm laceration was found in the mucosa behind the side wall of the right inferior nasal mucosa, and bleeding from the same part was confirmed. After endoscopic cauterization for hemostasis of the nasal mucosa, no rebleeding was observed. Although delayed epistaxis after Le Fort I osteotomy are often performed CT angiography to confirm the bleeding site, endoscopic cauterization would be primarily useful because of less invasiveness.

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Section: Discussionmentioning

confidence: 99%

Delayed Epistaxis which Was Developed after Orthognathic Surgery with Le Fort I Osteotomy and Managed by Endoscopic Cauterization

Kurasawa

Sato

Katada

et al. 2022

Case Reports in Dentistry

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“…However, the necessity of separating the pterygomaxillary junction with an osteotome is still controversial (16). Some clinical and experimental studies have shown that the fractures of the pterygoid plates can occur at different levels (9,11,17,18).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of strain values of critical anatomic regions for two different pterygomaxillary approaches in Le Fort I osteotomy: An experimental study

Ozdemir

Dolanmaz²,

Esen³

et al. 2017

Med Oral

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Background: The purpose of this experimental study was to measure stresses both on the pterygoid plates and the skull base following two different pterygomaxillary approaches in Le Fort I osteotomy. Material and Methods: The prepared skull models were randomly divided into 2 groups of 7. In the first group (A), the pterygomaxillary area was left intact. In the second group (B), pterygomaxillary separation was performed with a fine bur. The stresses were measured by using strain gauges. These strain gauges were attached to 6 different anatomical sites. The skull models were mounted on a servo-hydraulic testing unit. Each model was then subjected to a continuous linear tension until a plastic deformation was seen. Results: The statistical analyses showed that there were no significant differences (p>.05) between the 2 groups regarding the strain values. Moreover, no statistical differences (p>.05) were found between the two groups in terms of maximum applied forces. Conclusions: Considering the clinical conditions, the present study shows that when Le Fort I osteotomy performed without pterygomaxillary separation, there is no significant stress on the skull base during the downfracture. Moreover, it is considered that there is no need for an excessive force applied to perform downfracture in Le Fort osteotomies without pterygomaxillary separation.

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“…It is reported that LFI-non-COSep has gained only limited acceptance despite its potential to reduce the incidence of complications that can occur when an osteotome is used. 28 Therefore, it is essential to evaluate the risk of unfavourable fractures of the pterygoid process with and without the use of an osteotome. However, few studies have investigated pterygoid process fracture patterns during LFInon-COSep using CT images, 18,29 and there is insufficient knowledge regarding pterygomaxillary dysjunction-related fracture during LFI-non-COSep.…”

Section: Pterygomaxillary Junctionmentioning

confidence: 99%

Three-dimensional finite element model to predict patterns of pterygomaxillary dysjunction during Le Fort I osteotomy

Fujii

Kuroyanagi

Kanazawa

et al. 2017

International Journal of Oral and Maxillofacial Surgery

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The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction. The pterygomaxillary dysjunction patterns predicted by the 3D-FEA models of pterygomaxillary dysjunction were classified into three categories and compared to the pterygomaxillary dysjunction patterns observed in the postoperative 3D-CT images. Extension of the cutting line was also simulated using the 3D-FEA models to predict the risk and position of pterygoid process fracture. The rate of agreement between the predicted pterygomaxillary dysjunction patterns and those observed in the postoperative 3D-CT images was 87.0% (κ coefficient 0.79). The predicted incidence of pterygoid process fracture was higher for cutting lines that extended to the pterygomaxillary junction than for conventional cutting lines (odds ratio 4.75; P<0.0001). 3D-FEA can be used to predict pterygomaxillary dysjunction patterns during LFI-non-COSep and provides useful information for selecting safer procedures during LFI-non-COSep.

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Is an osteotome necessary for pterygomaxillary dysjunction or dysjunction through the tuberosity during Le Fort I osteotomy? A systematic review

Cited by 26 publications

References 42 publications

Delayed Epistaxis which Was Developed after Orthognathic Surgery with Le Fort I Osteotomy and Managed by Endoscopic Cauterization

Delayed Epistaxis which Was Developed after Orthognathic Surgery with Le Fort I Osteotomy and Managed by Endoscopic Cauterization

Evaluation of strain values of critical anatomic regions for two different pterygomaxillary approaches in Le Fort I osteotomy: An experimental study

Three-dimensional finite element model to predict patterns of pterygomaxillary dysjunction during Le Fort I osteotomy

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