A comparative study of three pterygomaxillary disjunction methods in Le Fort I osteotomy: a clinical and...

This study aimed to compare three pterygomaxillary disjunction (PMD) techniques-curved osteotome, non-instrumental technique, and ultrasonic bone scalpel-to identify the safest and most reliable method for Le Fort I osteotomy. This study included 152 patients who underwent orthognathic bimaxillary surgery to correct dentofacial deformities. Complete or incomplete PMD was evaluated using postoperative computed tomography (CT) images, and anatomical parameters of the pterygomaxillary junction were extracted from preoperative CT images. Patients were divided into three groups based on the PMD technique: curved osteotome, non-instrumental technique, and ultrasonic bone scalpel. No significant difference in achieving complete PMD was observed between the curved osteotome and non-instrumental technique (odds ratio [OD] = 1.09, 95% confidence interval [CI]: 0.59-2.02, p = 0.78). However, the ultrasonic bone scalpel had a significantly higher success rate of PMD than the curved osteotome (OD = 2.27, 95% CI: 1.24-4.22, p = 0.008). Younger age, female sex, skeletal Class III subjects, and a greater width and depth of the pterygomaxillary fissure are associated with complete PMD. No complications were observed in any of the patients. This study demonstrated that the ultrasonic bone scalpel is a safe technique with a high success rate for achieving complete PMD.