YBJOM-4555; No. of Pages 2
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Technical note
New device for palatal expansion in conjunction with the Le Fort I osteotomy Kazuhiro Matsushita a,∗ , Nobuo Inoue b , Yoshinori Kobori a , Kanchu Tei a a
Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan b Department of Gerodontology, Division of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan Accepted 15 June 2015
Keywords: Le Fort I osteotomy; Three-piece Le Fort I osteotomy; Palatal expansion
Introduction
Device and method
Narrowness of the jaw can cause posterior crossbite, which needs to be corrected by an orthognathic operation to establish proper lateral guidance of the teeth. When the basal arch of the alveolar bone in the molar region of the maxilla is too narrow, orthodontic treatment alone is unlikely to improve the crossbite without disturbing the axis of the teeth. In this case, a segmental osteotomy of the alveolar bone is necessary in conjunction with osteotomy of the jaw. Surgically-assisted rapid palatal expansion is the method usually used, but it involves a fan-shaped opening of the palate, which expands the front of the mouth more than the back. It is not the best strategy particularly when transverse expansion in molar region is required.1 A three-piece Le Fort I osteotomy is often done using a horseshoe-shaped circumpalatal osteotomy.2 Although a small amount of expansion can be achieved using this method of local manual manipulation, it does not always accomplish the required expansion of the palatal mucoperiosteum, which in our experience needs to be wider than 3-4 mm. We have developed a new palatal expander to stretch the palatal mucoperiosteum, irrespective of the conditions of the teeth and gingiva.
The device is similar to a self-retaining retractor with a pair of self-rotating lateral blades on the top, which have two pawls. The edges of the dentoalveolar segment should be held between these after the first osteotomy (Fig. 1). With the maxilla in the downfractured position, a thin carbide burr is used to make a horseshoe-shaped circumpalatal osteotomy (Fig. 2). The mucoperiosteum on both sides of the dentoalveolar segments should be sufficiently detached from above, through the osteotomy line, beyond the juncture of the horizontal palate, and through the vertical alveolar ridge. This should also extend as far as the underminings of the curved alveolar bone underneath. The left and right tips of the device, which have a pair of hooks on the top, are then inserted from
∗
Corresponding author. Tel./fax: +81 11 706 4283. E-mail address: [email protected] (K. Matsushita).
Fig. 1. The palatal expander. Insert: Magnified view of the pair of top blades, which are self-rotational and have two pawls, between which the wedge of cut bone is held.
http://dx.doi.org/10.1016/j.bjoms.2015.06.016 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Matsushita K, et al. New device for palatal expansion in conjunction with the Le Fort I osteotomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.06.016
YBJOM-4555; No. of Pages 2
2
ARTICLE IN PRESS K. Matsushita et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
above along the sagittal line of the osteotomy in each nasal floor. When the bony edge is firmly engaged to the fissure between the hooks, the device can gradually be expanded to the required width (Fig. 3). In our experience, this can be about 8-10 mm, although this depends on the original size of the arch. Within this range of movement, the mucoperiosteum has, so far, not been torn, and there has been no ischaemia.
Conflict of Interest There were no conflicts of interest. Fig. 2. Intraoperative view of the horseshoe osteotomy before the interincisal osteotomy.
Ethics statement/confirmation of patients’ permission Patients’ permission was not required.
References 1. Bailey LJ, White Jr RP, Proffit WR, et al. Segmental LeFort I osteotomy for management of transverse maxillary deficiency. J Oral Maxillofac Surg 1997;55:728–31. 2. Bell WH, Proffit WR, Jacobs J. Surgical widening of the maxilla. In: Bell WH, Proffit WR, White RP, editors. Surgical correction of dentofacial deformities, Vol 1. Philadelphia, PA: WB Saunders; 1980. p. 538–48.
Fig. 3. Intraoperative view of the expansion with the new device. The clasps are inserted along the osteotomy line. There is obvious cleavage at the interincisal union. This device does not work for a gradual expansion of the soft tissue like a distraction, but for a more acute expansion, in the place of manual manipulation.
Please cite this article in press as: Matsushita K, et al. New device for palatal expansion in conjunction with the Le Fort I osteotomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.06.016
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Technical note
New device for palatal expansion in conjunction with the Le Fort I osteotomy Kazuhiro Matsushita a,∗ , Nobuo Inoue b , Yoshinori Kobori a , Kanchu Tei a a
Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan b Department of Gerodontology, Division of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido 060-8586, Japan Accepted 15 June 2015
Keywords: Le Fort I osteotomy; Three-piece Le Fort I osteotomy; Palatal expansion
Introduction
Device and method
Narrowness of the jaw can cause posterior crossbite, which needs to be corrected by an orthognathic operation to establish proper lateral guidance of the teeth. When the basal arch of the alveolar bone in the molar region of the maxilla is too narrow, orthodontic treatment alone is unlikely to improve the crossbite without disturbing the axis of the teeth. In this case, a segmental osteotomy of the alveolar bone is necessary in conjunction with osteotomy of the jaw. Surgically-assisted rapid palatal expansion is the method usually used, but it involves a fan-shaped opening of the palate, which expands the front of the mouth more than the back. It is not the best strategy particularly when transverse expansion in molar region is required.1 A three-piece Le Fort I osteotomy is often done using a horseshoe-shaped circumpalatal osteotomy.2 Although a small amount of expansion can be achieved using this method of local manual manipulation, it does not always accomplish the required expansion of the palatal mucoperiosteum, which in our experience needs to be wider than 3-4 mm. We have developed a new palatal expander to stretch the palatal mucoperiosteum, irrespective of the conditions of the teeth and gingiva.
The device is similar to a self-retaining retractor with a pair of self-rotating lateral blades on the top, which have two pawls. The edges of the dentoalveolar segment should be held between these after the first osteotomy (Fig. 1). With the maxilla in the downfractured position, a thin carbide burr is used to make a horseshoe-shaped circumpalatal osteotomy (Fig. 2). The mucoperiosteum on both sides of the dentoalveolar segments should be sufficiently detached from above, through the osteotomy line, beyond the juncture of the horizontal palate, and through the vertical alveolar ridge. This should also extend as far as the underminings of the curved alveolar bone underneath. The left and right tips of the device, which have a pair of hooks on the top, are then inserted from
∗
Corresponding author. Tel./fax: +81 11 706 4283. E-mail address: [email protected] (K. Matsushita).
Fig. 1. The palatal expander. Insert: Magnified view of the pair of top blades, which are self-rotational and have two pawls, between which the wedge of cut bone is held.
http://dx.doi.org/10.1016/j.bjoms.2015.06.016 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Matsushita K, et al. New device for palatal expansion in conjunction with the Le Fort I osteotomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.06.016
YBJOM-4555; No. of Pages 2
2
ARTICLE IN PRESS K. Matsushita et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
above along the sagittal line of the osteotomy in each nasal floor. When the bony edge is firmly engaged to the fissure between the hooks, the device can gradually be expanded to the required width (Fig. 3). In our experience, this can be about 8-10 mm, although this depends on the original size of the arch. Within this range of movement, the mucoperiosteum has, so far, not been torn, and there has been no ischaemia.
Conflict of Interest There were no conflicts of interest. Fig. 2. Intraoperative view of the horseshoe osteotomy before the interincisal osteotomy.
Ethics statement/confirmation of patients’ permission Patients’ permission was not required.
References 1. Bailey LJ, White Jr RP, Proffit WR, et al. Segmental LeFort I osteotomy for management of transverse maxillary deficiency. J Oral Maxillofac Surg 1997;55:728–31. 2. Bell WH, Proffit WR, Jacobs J. Surgical widening of the maxilla. In: Bell WH, Proffit WR, White RP, editors. Surgical correction of dentofacial deformities, Vol 1. Philadelphia, PA: WB Saunders; 1980. p. 538–48.
Fig. 3. Intraoperative view of the expansion with the new device. The clasps are inserted along the osteotomy line. There is obvious cleavage at the interincisal union. This device does not work for a gradual expansion of the soft tissue like a distraction, but for a more acute expansion, in the place of manual manipulation.
Please cite this article in press as: Matsushita K, et al. New device for palatal expansion in conjunction with the Le Fort I osteotomy. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.06.016
![[Horseshoe Le Fort I osteotomy].](/assets/img/hold.png)
