Post-operative stability of the maxilla treated with Le Fort I and horseshoe osteotomies in bimaxillary surgery (original) (raw)
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Journal of Cranio-Maxillofacial Surgery, 1996
SUMMAR Y. In 25 patients with vertical maxillary deficiency, selected from a group of 410 Le Fort I osteotomies, the anterior part of the maxilla was repositioned inferiorly. Four groups could be distinguished. A group (n = 6) with downgrafting of the maxilla alone, fixed with wire osteosynthesis, a group (n-6) treated with Le Fort I and sagittal split osteotomy with a wire-fixed maxilla, a group (n = 8) with a Le Fort I and vertical ramus osteotomy where the maxilla was fixed with wire and a group (n = 5) treated by Le Fort I and vertical ramus osteotomy in which the maxilla had been fixed with miniplate osteosynthesis. In the group of single maxilla repositioning and in the bimaxillary group with a plate-fixed maxilla, the range of relapse was-0.3 mm to + 1.0 mm (mean + 0.4 mm) and 0 mm to + 1.0 mm (mean + 0.5 mm) respectively, which was not correlated to the distance of inferior repositioning. The bimaxillary cases, in which the maxilla had wire osteosynthesis, showed postoperative relapse ranging from-1. 4 mm to + 3.4 nun (mean + 1.3 mm) (sagittal split osteotomy) and-1. 1 mm to + 3.7 mm (mean + 1.2 mm) (vertical ramus osteotomy). In these cases the outcome of surgical intervention appeared completely unpredictable. If these figures are presented as percentages as is done in the literature in the majority of publications, a misleading impression appears. Likewise information about operation technique, fixation methods and linear measurements of movement and relapse (instead of percentages) are essential in comparing different studies.
Journal of Oral and Maxillofacial Surgery, 1998
This study compared single maxillary surgery and a two-jaw procedure in patients who underwent one-piece Le Fort I advancement without bone grafting. Patients and Methods: Fifty-three patients had Le Fort I osteotomy performed using a standard technique. Twenty-two patients had maxillary surgery alone, and 3 1 patients additionally had a bilateral sagittal split ramus osteotomy performed. Both rigid and nonrigid fixation were used. The postoperative movement of the maxilla was investigated, comparing cephalograms taken preoperatively, 2 to 3 days postoperatively, and at least 6 months postoperatively. A computer program was used to superimpose the three radiographs. Results: No difference in postoperative stability was found when the two surgical procedures were compared, and no correlation between magnitude of advancement and degree of relapse could be identified (P > .05). Nonrigid fixation in patients receiving only maxillary surgery resulted in greater postoperative forward movement of the maxilla (P = .022). Conclusion: This study indicates that postoperative stability of the maxilla in a two-jaw procedure is equivalent to that of single maxillary surgery. Nonrigid fixation in single maxillary surgery reduces the need for postoperative orthodontics. The Le Fort I osteotomy, introduced by Obwegeser' in the 1960s, and first evaluated by Willmar in 1974, is a commonly used operation in the management of midfacial deformities. In combination with the bilateral sagittal split ramus osteotomy,s it provides the most useful method for improving facial contour, eliminating asymmetries, and establishing good occlusion. Stability of the Le Fort I osteotomy is considered essential for a good result. Several parameters such as soft tissue traction,*6 amount of displacement,4,5,7,8 bone grafting,@ presence of clefts,7J0 type of lixa
… journal of oral and maxillofacial surgery, 1996
The purpose of ihis study was to determine whether better stability is achieved with genial bone grafts and four-plate rigid fixation for large advancement Le Fort I osteotomies of the maxilla than with nongrafted osteotomies. We analyzed radiographic data on 22 patients with obstructive sleep apnea syndrome. All patients underwent Le Fort I osteotomy for maxillary advancement, I 1 patients without bone grafts and 11 patients with bone grafts harvested from the mandibular symphyseal area. Bilateral sagittal split advancement osteotomies and genial tubercle advancements were also performed in all patients. Patients in the genial bone-grafted group had a mean advancement (surgical change) of 9.7 mm and a mean relapse (postsurgical change) of 0.7 mm (7%). Patients who had rigid fixation alone had a mean advancement of 10 mm and a mean relapse of 1.8 mm (18%). It is concluded that the stability with genial bone grafts to the lateral wall of the maxilla with four-plate rigid fixation was better than in the nongrafted group.
Clinical anatomy of the posterior maxilla pertaining to Le Fort I osteotomy in Thais
Clinical Anatomy, 2005
This article studies the anatomy of the posterior maxilla pertaining to bone-cut design of Le Fort I osteotomy to avoid the injury to the descending palatine artery in Thais. Fiftyfive skulls (38 males, 17 females) were assessed for the anatomical landmarks by a combination of direct inspection, computerized imaging, and computed tomography scan analysis. The results showed that 27.28% of the pterygomaxillary junction (PMJ) became synostosis. The mean heights of the PMJ, posterior maxilla, and maxillary tuberosity were 15.14 6 2.46 mm, 22.51 6 3.50 mm, and 7.45 6 2.76 mm, respectively. The mean length of the medial sinus wall measuring from the piriform rim to the descending palatine canal at the Le Fort I level was 34.40 6 2.96 mm. The mean widths of the posterior incision of Le Fort I osteotomy at the maxillary tuberosity and PMJ were 20.38 6 2.82 mm and 11.60 6 1.57 mm. The mean length of the posterior maxilla was 27.18 6 2.49 mm. Distances from the greater palatine foramen to the maxillary tuberosity incision and PMJ incision were 1.76 6 1.12 mm and 3.59 6 1.40 mm. The mean angle between the descending palatine canal and the hard palate was 57.33 6 4.548. There were no significant differences in any measurements between sides and genders, except the pterygoid process width and posterior maxilla length of males were longer than those of females (P < 0.05). This study could provide better understanding of the posterior maxillary anatomy that is important for the bone-cut design of Le Fort I osteotomy to avoid excessive intraoperative and postoperative hemorrhage including ischemia of the mobilized maxilla.