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Transmaxillary Sinus Approach for Le Fort II Osteotomy
Shinji Kobayashi1, Toshihiko Fukawa1, Takashi Hirakawa1
1Department of Plastic and Reconstructive Surgery, Kangawa Children's Medical Center, Kangawa, Japan; Fukawa Orthodontic Office, Kamakura-shi, Kanagawa, Japan; Hirakawa Orthodontic Clinic, Kanagawa, Japan; and Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
The transmaxillary sinus approach (TSA) simplifies Le Fort II osteotomy by allowing direct visualization and cutting of the maxillary sinus posterior wall. This technique offers a minimally invasive option for syndromic craniosynostosis surgery.
Area of Science:
- Oral and Maxillofacial Surgery
- Craniofacial Surgery
- Pediatric Plastic Surgery
Background:
- Le Fort II osteotomy is a complex procedure, particularly the posterior wall osteotomy of the maxillary sinus (MS).
- Existing techniques for Le Fort II osteotomy can be challenging and carry risks of complications.
- Syndromic craniosynostosis often requires complex craniofacial reconstructions, including midface advancement.
Purpose of the Study:
- To introduce and illustrate a novel, easy-to-use transmaxillary sinus approach (TSA) for performing Le Fort II osteotomy.
- To evaluate the efficacy and advantages of the TSA in patients with syndromic craniosynostosis.
- To demonstrate direct visualization and osteotomy of the maxillary sinus posterior wall.
Main Methods:
- Developed and applied the transmaxillary sinus approach (TSA) for Le Fort II osteotomy.
- Utilized an intraoral approach to remove thin anterior walls of the maxillary sinus for direct visualization.
- Performed posterior wall osteotomy of the maxillary sinus using a chisel under direct vision with light.
- Combined with distraction osteogenesis using internal and external devices.
Main Results:
- Successfully performed Le Fort II osteotomy using the TSA in two patients with syndromic craniosynostosis (Apert and Pfeiffer syndromes).
- Achieved direct posterior wall osteotomy of the maxillary sinus without down fracture.
- Demonstrated minimal invasiveness to the maxillary sinus mucosa under direct vision.
- Identified TSA as a blind procedure in cases with absent or hypoplastic maxillary sinuses.
Conclusions:
- The transmaxillary sinus approach (TSA) is an effective and direct method for performing the posterior wall osteotomy of the maxillary sinus in Le Fort II osteotomies.
- TSA offers advantages of direct visualization, no down fracture, and minimal invasiveness.
- This technique is particularly useful for Le Fort II osteotomies in syndromic craniosynostosis cases with well-developed maxillary sinuses.
