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What are the Pterygomaxillary Fracture Patterns in Cleft Orthognathic Surgery?
Isabela Toledo Teixeira da Silveira1, Bruno Gomes Duarte2, Luciano Reis de Araújo Carvalho1
1Doctorate Student, Faculty of Dentistry of Bauru, Department of Surgery, Stomatology, Pathology and Radiology, University of São Paulo, Bauru, São Paulo, Brazil.
Summary
Performing Le Fort I osteotomy above the pterygomaxillary junction (PMJ) in cleft lip and palate patients significantly increases unfavorable fracture risks. Performing osteotomies at the PMJ level is recommended to minimize these complications.
Area of Science:
- Craniofacial surgery
- Orthognathic surgery
- Cleft lip and palate (CLP) treatment
Background:
- Patients with cleft lip and palate (CLP) present unique pterygoid plate anatomy.
- These anatomical variations can influence fracture patterns during Le Fort I osteotomy at the pterygomaxillary junction (PMJ).
- This increases the risk of unfavorable fractures, complicating surgical outcomes and patient recovery.
Purpose of the Study:
- To evaluate the association between osteotomy level and pterygomaxillary junction (PMJ) fracture patterns.
- To assess the impact of osteotomy placement relative to the PMJ in patients with cleft lip and palate undergoing Le Fort I osteotomy.
Main Methods:
- Retrospective cohort study of 100 patients with cleft lip and palate.
- Analysis of preoperative tomographic scans to measure pterygomaxillary suture morphometrics.
- Comparison of fracture patterns (favorable vs. unfavorable) based on osteotomy level (at or above the PMJ).
Main Results:
- Unfavorable fractures were significantly more frequent when osteotomy was performed above the PMJ (P < .005).
- Relative risk for unfavorable fractures was substantially higher on both the right (23.06) and left (65.00) sides when osteotomy was above the PMJ.
- The study included 100 participants with a mean age of 23 years.
Conclusions:
- Performing Le Fort I osteotomy at the level of the pterygomaxillary junction (PMJ) is recommended.
- This approach can reduce the incidence of inadvertent pterygomaxillary fractures in cleft surgery.
- Optimizing osteotomy placement is crucial for improving surgical safety and outcomes in CLP patients.
