Alternative approaches to pterygomaxillary separation

Area of Science:

• Oral and Maxillofacial Surgery
• Anatomical Studies
• Surgical Techniques

Background:

• Le Fort I osteotomy is a common surgical procedure for midface correction.
• Pterygomaxillary separation during this procedure can lead to pterygoid plate fractures.
• These fractures may extend to the skull base and orbit, causing rare but significant complications.

Purpose of the Study:

• To evaluate alternative surgical approaches for pterygomaxillary dysjunction in Le Fort I osteotomy.
• To identify techniques that minimize the risk of high-level pterygoid plate fractures.
• To compare the efficacy and safety of different instruments for pterygomaxillary separation.

Main Methods:

• The study involved dissecting 50 fresh cadavers.
• Five distinct methods for achieving pterygomaxillary dysjunction were analyzed.
• Fracture patterns and locations were meticulously documented for each method.

Main Results:

• The use of a curved Obwegeser osteotome resulted in a high incidence of pterygoid plate fractures near the skull base.
• These fractures were deemed unacceptable due to their proximity to critical structures.
• The Stryker micro-oscillating saw demonstrated superior outcomes with significantly fewer high-level fractures.

Conclusions:

• The Obwegeser osteotome technique for pterygomaxillary dysjunction should be discontinued.
• The Stryker micro-oscillating saw is the preferred instrument for pterygomaxillary separation in Le Fort I osteotomy.
• Utilizing the oscillating saw enhances surgical safety by reducing the risk of complex fractures.