Endoscopically assisted Le Fort I osteotomy using an ultrasonic scalpel: a feasibility study in cadavers

Drawbacks to conventional Le Fort I osteotomy include bleeding, infection, and relapse. The open approach predisposes itself to each of these complications through various means. We performed an endoscopically assisted Le Fort I osteotomy with an ultrasonic scalpel in cadavers to develop a new technique that minimizes such complications.

Endoscopically assisted Le Fort I osteotomy was performed in 4 fresh adult human cadavers. Two 1-cm gingivobuccal sulcus incisions were used to approach the maxilla. Osteotomies were carried out with an ultrasonic scalpel from within the maxillary sinus under endoscopic visualization after a small antrostomy was made in its anterior wall. The external periosteal sleeve to the maxilla remained intact, eliminating the risk of massive hemorrhage and preserving bony vascularity. A stab incision was made with a 2-mm osteotome above the anterior nasal spine to separate the caudal septum from the Le Fort I segment. Pterygomaxillary disjunction was also performed with classic osteotomes. Disimpaction was completed with minor digital pressure inferiorly.

Each of the 4 Le Fort I osteotomies was complete, and mobility was checked by manual examination. There was a steep learning curve to the operation, but the final cadaveric dissection took 37 minutes to complete. At no time did the ultrasonic scalpel violate the maxillary periosteum as judged by postoperative direct examination.

This cadaveric study shows the feasibility of an endoscopically assisted Le Fort I osteotomy by use of an ultrasonic scalpel. Further experimental work combined with refinements in technique and equipment will help bring this advancement into clinical application.