Prospective study of the incidence of serious posterior maxillary haemorrhage during a tuberosity osteotomy in low level Le Fort I operations

O’Regan, Barry; Bharadwaj, Girish

doi:10.1016/j.bjoms.2007.03.006

Cited by 47 publications

(19 citation statements)

References 22 publications

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“…21,22 Successful separation of the pterygomaxillary junction depends greatly on technique. One method involves separation of the pterygoid plate from the posterior maxilla using Tessier distraction forceps applied initially at the piriform rims and then later at the maxillary tuberosity, rather than an osteotome.…”

Section: Discussionmentioning

confidence: 99%

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

Ueki

Hashiba

Marukawa

et al. 2009

Journal of Oral and Maxillofacial Surgery

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Purpose. The purpose of this study was to examine the separation of the pterygomaxillary region at the posterior nasal spine level after Le Fort I osteotomy in Class III patients.Patients and Methods. The study group consisted of 37 Japanese patients with mandibular prognathism and asymmetry, with maxillary retrognathism or asymmetry. A total of 74 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.Postoperative computed tomography (CT) was analyzed for all patients. The separation of the pterygomaxillary region and the location of the descending palatine artery were assessed.Results. Although acceptable separation between the maxilla and pterygoid plates was achieved in all patients, an exact separation of the pterygomaxillary junction at the posterior nasal spine level was found in only 18 of 74 sides (24%). In 29 of 74 sides (39.2%), the separation occurred anterior to the descending palatine artery. In 29 of 74 sides (39.2%), complete separation between the maxilla and lateral and/or medial pterygoid plate was not achieved, but lower-level separation of the maxilla and pterygoid plate was always complete. The maxillary segments could be moved to the postoperative ideal position in all cases.Conclusion. Le Fort I osteotomy without an osteotome does not always induce an exact separation at the pterygomaxillary junction at the posterior nasal spine level, but the ultrasonic bone curette can remove the interference between maxillary segment and pterygoid plates more safely.

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Section: Discussionmentioning

confidence: 99%

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

Ueki

Hashiba

Marukawa

et al. 2009

Journal of Oral and Maxillofacial Surgery

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“…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%

“…However, these programs use different reconstruction algorithms and/or methods of measurement ultimately intended to aid professionals in formulating more accurate maxillofacial diagnosis and treatment plans. The reconstruction pattern may be determined by surface rendering or volumetric rendering as previously investigated, 10,24 although the evaluation of patterns of linear measurement remains unclear.…”

Section: -17mentioning

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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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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“…In the series of cases of haemorrhage in literature following Le Fort I osteotomies, the vast majority of initial episodes occurred within the first 14 days post-operatively [11]. In a study conducted by Regan and Bhardwaj [16] no patient had post-operative arterial or venous haemorrhage that required return to operation theatre. In our study all the patients recovered well post-operatively without any vascular complications.…”

Section: Vascular Complicationsmentioning

confidence: 98%

Evaluation of Post-operative Complication Rate of Le Fort I Osteotomy: A Retrospective and Prospective Study

Garg

Kaur

2012

J. Maxillofac. Oral Surg.

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Le Fort I osteotomy has become a routine procedure in elective orthognathic surgery. This procedure is often associated with significant but rare post-operative complications. The study was conducted to evaluate the rate of post-operative complications following conventional Le Fort I osteotomy. Twenty-five healthy adult patients who had to undergo Le Fort I osteotomy without segmentalization of maxilla were included in the study based on indications of surgery. All the patients were followed up for a period of 6 months post-operatively to assess the rate of various post-operative complications such as neurosensory deficit, pulpal sensibility, maxillary sinusitis, vascular complications, aseptic necrosis, unfavourable fractures, ophthalmic complications and instability or non-union of maxilla, etc. The results of our study showed a post-operative complications rate of 4 %. Neurosensory deficit and loss of tooth sensibility were the most common findings during patient evaluation at varying follow-up periods while one patient presented with signs and symptoms of maxillary sinusitis post-operatively. Neurosensory as well as sinusitis recovery took place in almost all the patients within 6 months. It was concluded that thorough understanding of pathophysiological aspects of various complications, careful assessment, treatment planning and the use of proper surgical technique as well as instrumentation may help in further reducing the complication rate.

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Prospective study of the incidence of serious posterior maxillary haemorrhage during a tuberosity osteotomy in low level Le Fort I operations

Cited by 47 publications

References 22 publications

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

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

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

Evaluation of Post-operative Complication Rate of Le Fort I Osteotomy: A Retrospective and Prospective Study

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