J
Oral MamllofaC SurQ
48323,
1990
Altered-Sequence
Le Fort
Pterygoid-Tuberosity ARTURO
Discussion A retrospective clinical study was performed on 14 patients treated in private practive. Seven osteotomies were performed using the standard technique and 7 with the altered Le Fort I osteotomy. Six of 7 patients treated with the standard Le Fort I technique showed unilateral or bilateral pterygoid plate fractures, and complete mobilization of the MPC was technically difficult. Some patients also had a fracture of the posterior wall of the maxillary antrum. In 6 of the 7 patients treated with the altered sequence, completely intact pterygoid plates separated from the maxillary tuberosities and remained attached to the base of the skull. Unilateral pterygoid plate fracture occurred in only 1 case. These surgical events were carefully determined intraoperatevely by direct visual and tactile inspection.
In the classical description of the Le Fort I osteotomy, the last of the cuts involves separation of the maxilla from the pterygoid plates with a curved osteotome malleted medially and anteriorly into the pterygomaxillary suture. This produces radiating
References
* In private practice, Arecibo, PR. Address correspondence and reprint requests to Dr Vargas: Andres Oliver St, No. 52-A, Arecibo, PR 00612. of Oral and Maxillofacial
DDS*
vibrations to the partially osteotomized complex and can contribute to the frequently occurring pterygoid plate fracture and associated complications. In the altered-sequence osteotomy the pterygoid-tuberosity dysjunction is done before cutting the postero-medial wall of the maxillary sinus. This stabilizes the maxilla and avoids improper fracture of the pterygoid plates.
Technique
Association
Osteotomy:
Dysjunction
VARGAS-GARCIA,
The standard Le Fort I osteotomy technique often requires separation of the pterygoid plates from the maxillary tuberosity by the use of a curved osteotome. The ideal fracture separates the pterygoid process from the maxillary tuberosity without damage to either part.’ Improperly directed force at the pterygoid-tuberosity junction, however, can cause the fracture line to diverge from the desired plane. As a consequence, fracture through the pterygoid process or damage to the pterygopalatine canal can occur.’ This report describes an altered sequence for the total horizontal maxillary osteotomy that avoids inappropriate fracture of the pterygoid plates. The altered technique may be used as a standard procedure in all low-level maxillary surgeries. The procedure is technically less difficult and more predictable, and has several advantages, particularly when mobilization of the maxillopalatine complex (MPC) is planned.
0 1990 American geons
I
1. Bell WH, Profflit WR, White RP: Surgical Correction of Dentofacial Deformities (ed II. Philadelphia. PA. Saunders, 1980, pp 353,493 1 2. Wikkeling OME, Tacoma J: Osteotomy of the pterygomaxillary junction. Int J Oral Surg 499, 1975
Sur-
0278-2391190/4803-0019$3.00/O
323
Oral MamllofaC SurQ
48323,
1990
Altered-Sequence
Le Fort
Pterygoid-Tuberosity ARTURO
Discussion A retrospective clinical study was performed on 14 patients treated in private practive. Seven osteotomies were performed using the standard technique and 7 with the altered Le Fort I osteotomy. Six of 7 patients treated with the standard Le Fort I technique showed unilateral or bilateral pterygoid plate fractures, and complete mobilization of the MPC was technically difficult. Some patients also had a fracture of the posterior wall of the maxillary antrum. In 6 of the 7 patients treated with the altered sequence, completely intact pterygoid plates separated from the maxillary tuberosities and remained attached to the base of the skull. Unilateral pterygoid plate fracture occurred in only 1 case. These surgical events were carefully determined intraoperatevely by direct visual and tactile inspection.
In the classical description of the Le Fort I osteotomy, the last of the cuts involves separation of the maxilla from the pterygoid plates with a curved osteotome malleted medially and anteriorly into the pterygomaxillary suture. This produces radiating
References
* In private practice, Arecibo, PR. Address correspondence and reprint requests to Dr Vargas: Andres Oliver St, No. 52-A, Arecibo, PR 00612. of Oral and Maxillofacial
DDS*
vibrations to the partially osteotomized complex and can contribute to the frequently occurring pterygoid plate fracture and associated complications. In the altered-sequence osteotomy the pterygoid-tuberosity dysjunction is done before cutting the postero-medial wall of the maxillary sinus. This stabilizes the maxilla and avoids improper fracture of the pterygoid plates.
Technique
Association
Osteotomy:
Dysjunction
VARGAS-GARCIA,
The standard Le Fort I osteotomy technique often requires separation of the pterygoid plates from the maxillary tuberosity by the use of a curved osteotome. The ideal fracture separates the pterygoid process from the maxillary tuberosity without damage to either part.’ Improperly directed force at the pterygoid-tuberosity junction, however, can cause the fracture line to diverge from the desired plane. As a consequence, fracture through the pterygoid process or damage to the pterygopalatine canal can occur.’ This report describes an altered sequence for the total horizontal maxillary osteotomy that avoids inappropriate fracture of the pterygoid plates. The altered technique may be used as a standard procedure in all low-level maxillary surgeries. The procedure is technically less difficult and more predictable, and has several advantages, particularly when mobilization of the maxillopalatine complex (MPC) is planned.
0 1990 American geons
I
1. Bell WH, Profflit WR, White RP: Surgical Correction of Dentofacial Deformities (ed II. Philadelphia. PA. Saunders, 1980, pp 353,493 1 2. Wikkeling OME, Tacoma J: Osteotomy of the pterygomaxillary junction. Int J Oral Surg 499, 1975
Sur-
0278-2391190/4803-0019$3.00/O
323
![[Horseshoe Le Fort I osteotomy].](/assets/img/hold.png)
