[Endoscopically-assisted LeFort I osteotomy in distraction procedures of the maxilla]

The purpose of this study was to demonstrate the feasibility of combining a minimally invasive endoscopic approach to the maxilla with transverse and sagittal distraction procedures.

Four human cadavers were used for training of a minimally invasive access to the maxilla to perform an endoscopically assisted Le Fort I osteotomy, before this technique was applied in three patients with transverse and sagittal growth deficits of the maxilla. Access to the maxilla was gained through a small mucosa incision in the vestibule to create a visualization port to the maxillary sinus through a bur hole. Landmarks were identified through the endoscope before a Le Fort I osteotomy was performed using straight and angulated chisels of different form and angulation. In two patients, the maxilla was split sagittally to perform a transverse maxillary expansion. In one patient, a buried distractor was applied close to the piriform aperture to correct a sagittal growth deficit in a hypoplastic maxilla.

The endoscopic exposure of the maxillary sinus walls from within the sinus, the accurate identification of landmarks, and the creation of a Le Fort I osteotomy was achieved in all cases. Distractor application close to the piriform aperture rendered good stability.

The results of these case reports indicate that the endoscopic approach to the maxillary sinus allows excellent exposure of the sinus walls to perform an endoscopically assisted Le Fort I osteotomy. The combination of endoscopy and osteodistraction supports the trend toward minimally invasive, less traumatic surgical procedures, especially in individuals still growing.