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Yari A, Hasheminasab M, Badri A, Tanbakuchi B, Fasih P. Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. Oral Maxillofac Surg 2024; 28:935-943. [PMID: 37486423 DOI: 10.1007/s10006-023-01174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to assess the accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. MATERIALS AND METHODS A total of 73 patients undergoing single-piece LeFort I osteotomies in the maxilla and bilateral sagittal split osteotomies in the mandible were included in the study. Preoperative and immediate postoperative cone-beam CT were compared in computer software (Dolphin3D©). Maxillary landmarks relative to the vertical and horizontal reference lines were evaluated. The difference between the planned and achieved maxillary positions was measured. Distance error in millimeters and achievement ratio (achieved displacement/planned displacement*100) were calculated for different maxillary movements. RESULTS Midline correction and advancement were the most accurate movements with an overall mean distance error of 0.53 mm and 0.63 mm respectively while posterior impaction and setback were the least accurate movements with 1.38 mm and 1.76 mm mean discrepancies, respectively. A significant difference was observed only in setback movement regarding the discrepancy value (P < .05). Although setback and down-graft movements tended to under-correction, all other movements were overcorrected. As the magnitude of maxillary movements increases, the accuracy decreases. In severe displacements (≥ 8 mm), the accuracy declines significantly (P < .05). CONCLUSION Classic cast surgery and manually fabricated intermediate splints in teaching hospitals yield accurate and acceptable results in the majority of cases (84.6%). The accuracy of maxillary repositioning decreases as the magnitude of displacement increases.
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Affiliation(s)
- Amir Yari
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahboube Hasheminasab
- Department of Orthodontics, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - Amirali Badri
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrad Tanbakuchi
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Paniz Fasih
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Beek DM, Visser DJ, Chen YH, Baan F, Nienhuijs M, Xi T. Is there a difference in surgical accuracy following bimaxillary surgery between cleft and non-cleft patients? Clin Oral Investig 2024; 28:112. [PMID: 38265487 PMCID: PMC10808377 DOI: 10.1007/s00784-024-05517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To assess the surgical accuracy of 3D virtually planned orthognathic surgery among patients with and without cleft. MATERIALS AND METHODS This retrospective cohort study included cleft and non-cleft patients with class III malocclusion who underwent bimaxillary surgery. CBCT scans were acquired before and immediately after surgery. 3D virtual surgical planning (VSP) was performed using CBCT and digitalized dentition data. All orthognathic surgeries were performed by the same surgeons using interocclusal splints. The primary outcome variable was surgical accuracy, defined as the difference between the planned and surgically achieved maxillary movements, quantified in six degrees of freedom. Analysis of covariance was used to test for intergroup differences in surgical accuracy after correcting for differences in the magnitude of planned surgical maxillary movements. RESULTS Twenty-eight cleft and 33 non-cleft patients were enrolled, with mean ages of 18.5 and 25.4 years, respectively (P=0.01). No significant gender difference was present between the groups (P=0.10). After adjustment for small differences in surgical movements, no significant differences in surgical accuracy were observed between cleft and non-cleft patients. CONCLUSION The present study demonstrates that high surgical accuracy in maxillary movements can be achieved in both cleft and non-cleft patients using VSP and interocclusal splints. CLINICAL RELEVANCE Orthognathic cases with cleft can be performed with 3D VSP to obtain a satisfactory surgical accuracy.
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Affiliation(s)
- Dirk-Melle Beek
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands
| | - Dirk-Jan Visser
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands
| | - Yi-Hsuan Chen
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands
- Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan branch, No. 123, Dinghu Road, Guishan District, Taoyuan, 333, Taiwan
| | - Frank Baan
- Radboudumc 3D Lab, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands
| | - Marloes Nienhuijs
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6500, Nijmegen, HB, Netherlands.
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Govaerts D, Da Costa O, Garip M, Combes F, Jacobs R, Politis C. Can surgically assisted rapid palatal expansion (SARPE) be recommended over orthodontic rapid palatal expansion (ORPE) for girls above the age of 14? : A cone-beam CT study on midpalatal suture maturation. J Orofac Orthop 2023:10.1007/s00056-023-00487-x. [PMID: 37407791 DOI: 10.1007/s00056-023-00487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND For patients with a maxillary transversal deficiency (MTD), various treatment options are available, partly based on the practitioner's experience. This study aimed to determine a cut-off age for decision making between surgically assisted rapid palatal expansion (SARPE) over orthodontic rapid palatal expansion (ORPE) based on skeletal maturation in a female population. METHODS A total of 100 cone beam computed tomography (CBCT) images of young females were analyzed on maturation of the pterygomaxillary (PMS), zygomaticomaxillary (ZMS), transpalatal (TPS), and midpalatal (MPS) sutures. Based on the maturation of these four junctions, four independent observers had to determine whether they would prefer ORPE or SARPE to widen the maxilla. RESULTS For the PMS, the results show a closure of 83-100% from 13 to 17 years. As for the TPS, a closure of 78-85% was observed from 15 years of age. For the 15- to 17-year-old females, a closed ZMS was present in 32-47%. Regarding MPS, closed sutures presented in 61% (stages D and E) of the 15-year-old females. The cut-off age at which SARPE was recommended was 15.1 years for the orthodontist observers and 14.8 years for the maxillofacial surgeon observers. CONCLUSIONS Significant maturation of MPS was reached at the age of 15 in a female population. The PMS, TPS, MPS, and ZMS closed sequentially. A comprehensive diagnostic approach is necessary for choosing the appropriate treatment. When in doubt, age could assist decision making in a female population, with a cut-off age of 15 years in favor of SARPE based on this study.
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Affiliation(s)
- Dries Govaerts
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Oliver Da Costa
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melisa Garip
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - François Combes
- Department of Oral and Maxillofacial Surgery, AZ Delta Hospital, Roeselare, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Leung YY, Leung JKC, Li ATC, Teo NEZ, Leung KPY, Au SW, Li DTS, Su YX. Accuracy and safety of in-house surgeon-designed three-dimensional-printed patient-specific implants for wafer-less Le Fort I osteotomy. Clin Oral Investig 2023; 27:705-713. [PMID: 36401069 DOI: 10.1007/s00784-022-04798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The design and fabrication of three-dimensional (3D)-printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. MATERIALS AND METHODS The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines, and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. RESULTS The median linear deviations of the post-operative maxilla of the x, y, and z axes were 0.74 mm, 0.75 mm, and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw, and roll were 1.40°, 0.90°, and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. CONCLUSIONS The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. CLINICAL RELEVANCE Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery. TRIAL REGISTRATION Clinical trial registration number: HKUCTR-2113. Date of registration: 29 July 2016.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Jasper Ka Chai Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin Tsz Choi Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Nathan En Zuo Teo
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karen Pui Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Shun Wai Au
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yu-Xiong Su
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong
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Maxillary Total Elongation Surgery using 3D Virtual Surgery, CAD/CAM and 3D Printing Technology: Surgical Convenience and Accuracy. J Craniofac Surg 2022; 33:2172-2177. [DOI: 10.1097/scs.0000000000008757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022] Open
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Accuracy of Mandible-First versus Maxilla-First Approach and of Thick versus Thin Splints for Skeletal Position after Two-Jaw Orthognathic Surgery. Plast Reconstr Surg 2021; 147:421-431. [PMID: 33235045 DOI: 10.1097/prs.0000000000007536] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the accuracy of bimaxillary orthognathic surgery regarding different sequencing (maxilla-first or mandible-first surgery) and different thicknesses of intermediate splints. METHODS This retrospective cohort study evaluated the accuracy of postoperative outcome in accordance with virtual planning in 57 patients requiring bimaxillary osteotomies with different operation sequence: maxilla-first (n = 31) or mandible-first (n = 26) surgery. The effect of different splint thicknesses (i.e., thick, n = 22; and thin, n = 35) was also evaluated. The 1-week postoperative cone-beam computed tomographic craniofacial images were superimposed onto preoperative simulated images to measure the discrepancy of the three-dimensional cephalometric landmarks. RESULTS Neither sequencing approach differed in overall accuracy (1-week postoperative to preoperative simulated image discrepancy): maxilla-first, 1.69 ± 0.53 mm; versus mandible-first, 1.44 ± 0.52 mm. In detailed comparison, mandible-first surgery resulted in more accuracy in the vertical dimension. Thick intermediate splints provided better control (less error) of upper central incisors in the sagittal position (thick splint, 1.38 ± 1.17 mm; thin splint, 2.13 ± 1.38 mm). However, overall accuracy was not affected by splint thickness. Conditions affecting sequencing predilection included skeletal class III with vertical excess, maxillary down-grafting, counterclockwise rotation of the maxillomandibular complex, and simulated mandibular opening for splint fabrication clearance. CONCLUSIONS Despite both means of sequencing being performed similarly, mandible-first surgery was more precise in the vertical dimension. Thick intermediate splints seemed to yield better control of central incisors in the sagittal position. However, under appropriate selection of intermediate splints to maintain interim condylar position, splint thickness has no effect on overall accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Kraeima J, Schepers R, Spijkervet F, Maal T, Baan F, Witjes M, Jansma J. Splintless surgery using patient-specific osteosynthesis in Le Fort I osteotomies: a randomized controlled multi-centre trial. Int J Oral Maxillofac Surg 2020; 49:454-460. [DOI: 10.1016/j.ijom.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/30/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
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Lartizien R, Zaccaria I, Noyelles L, Bettega G. Quantification of the inaccuracy of conventional articulator model surgery in Le Fort 1 osteotomy: evaluation of 30 patients controlled by the Orthopilot ® navigation system. Br J Oral Maxillofac Surg 2019; 57:672-677. [PMID: 31256987 DOI: 10.1016/j.bjoms.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
Occlusal splints are commonly used to position the maxilla during traditional orthognathic surgery. We aimed to quantify the inaccuracy of the maxillary positioning (in three dimensions) in traditional model surgery with the Orthopilot® navigation system. Thirty Le Fort I osteotomies were made using a standard technique. The position of the maxilla was recorded by the navigation system and defined by three values of translation and three of rotation. The recorded data were compared with the planned data. The accuracy of positioning was classified in distinct classes with three major criteria (conformity, non-conformity, and failure) according to the discrepancy. The positioning of the maxilla was in conformity with operative planning in 3/30 of our Le Fort I osteotomies (95% CI 2% to 27%) and in failure in 22/30 (95% CI 54% to 88%). The dispersion of the discrepancy was more important in the sagittal plane, particularly for the sagittal rotation and for the back-front translation, which reflected greater inaccuracy in this plan. The frontal orientation of the maxilla was better controlled. The risk of maxillary malposition was proportional to the planned maxillary advancement.
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Affiliation(s)
- R Lartizien
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France; Université Grenoble Alpes, Medicine Faculty, 23 Avenue Maquis du Grésivaudan, 38700, La Tronche, France.
| | - I Zaccaria
- Clinical research department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - L Noyelles
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
| | - G Bettega
- Maxillofacial surgery department, Annecy Genevois Hospital, 1 avenue de l'hôpital, 74370, Epagny Metz-Tessy, France
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Mulier D, Shaheen E, Shujaat S, Fieuws S, Jacobs R, Politis C. How accurate is digital-assisted Le Fort I maxillary osteotomy? A three-dimensional perspective. Int J Oral Maxillofac Surg 2019; 49:69-74. [PMID: 31266680 DOI: 10.1016/j.ijom.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/28/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the surgical accuracy of Le Fort I surgery compared to the three-dimensional (3D) virtual planning. Fifty-five patients (29 males, 26 females; age range 15-58 years) with skeletal class III malocclusion, who underwent bimaxillary surgery were included. A validated 3D accuracy assessment tool was utilized to assess the surgical accuracy of the maxillary positioning. For translational movements, the least amount of error was associated with mediolateral translation, whereas the surgical accuracy for anteroposterior and superoinferior translation showed a tendency towards a more posterior and inferior positioning of the maxilla compared to the planning. For rotational movements, the highest discrepancy was observed for pitch. Linear regression showed increased inaccuracy with increasing advancement for anteroposterior, superoinferior and pitch movements. To conclude, 3D virtual planning of maxilla was generally accurate when compared to achieved outcome for skeletal class III patients undergoing bimaxillary surgery.
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Affiliation(s)
- D Mulier
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - E Shaheen
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven-University of Leuven, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Tomomatsu N, Kurohara K, Nakakuki K, Yoshitake H, Kanemaru T, Yamaguchi S, Yoda T. Influence of the anatomical form of the posterior maxilla on the reliability of superior maxillary repositioning by Le Fort I osteotomy. Int J Oral Maxillofac Surg 2018; 48:612-619. [PMID: 30503635 DOI: 10.1016/j.ijom.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 11/18/2022]
Abstract
Certain patients with facial deformities require superior repositioning of the maxilla via Le Fort I osteotomy; however, the magnitude of superior repositioning of the maxilla is often less than expected. In this study, the correlation between the accuracy of superior repositioning of the maxilla and the anatomical form of the maxillary posterior region was examined. Seventy-five patients who underwent Le Fort I osteotomy without forward movement of the maxilla but with superior repositioning of the maxilla were included in this study. The bone volume around the descending palatine artery (DPA), the angle of the junction between the pterygoid process and the tuberosity, and the distance between the upper second molar and the pterygoid process were measured via three-dimensional analysis. A significant negative correlation (r=-0.566) was found between the bone volume around the DPA and the ratio of repositioning (actual movement divided by expected movement). It is possible that the superior repositioning of the maxilla expected prior to surgery was not sufficiently attained because of the large volume of bone around the DPA. The results of this study show that in some patients, superior repositioning was not achieved at the expected level because of bone interference attributable to the anatomical form of the maxillary posterior region.
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Affiliation(s)
- N Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kurohara
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - K Nakakuki
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Yoshitake
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Kanemaru
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Yamaguchi
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Yoda
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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