New method of endoscopic pterygomaxillary disjunction for a Le Fort Type I osteotomy

Endoscopic pterygomaxillary (PM) disjunction in a Le Fort type I osteotomy is presented, and the versatility of this new technique is discussed on the basis of our own experience. We have reexamined the anatomy of the posterior part of the maxilla, focusing in particular on the neurovascular bundle, to attempt to perform the endoscopic PM disjunction through the maxillary sinus along a new osteotomy line. We found that the use of an endoscope provided a magnified field of vision and a view of the objects being manipulated on a television monitor, thereby reducing the necessity of working blind. We have applied this technique in 10 clinical cases, and in all cases the Le Fort type I osteotomy was accomplished safely and with minimal bleeding. The operative time using an endoscope was about 15 minutes to 20 minutes on each side, and the blood loss during this manipulation was less than 50 mL. The application of the endoscope should widen in craniofacial surgical field when its advantages are recognized and new operative approaches for using it are developed.