Abstract
Pterygomaxillary disarticulation (PMD) contributes to surgical complications of Le
Fort 1 osteotomy and is associated with undesirable fractures of the pterygoid plates.
The aim of this paper was to investigate the patterns of PMD in Le Fort I osteotomies
using Rowe's disimpaction forceps, and to evaluate correlations with age and anatomical
measurements. Cone-beam computed tomography (CBCT) scans of 70 consecutive orthognathic
patients were retrospectively evaluated to study four patterns of PMD: Type 1 - PMD
at, or anterior to, the pterygomaxillary junction (PMJ); Type 2 - PMD posterior to
the PMJ; Type 3 - PMJ separation with comminuted fracture of the pterygoid plates;
Type 4 - disarticulation of the maxilla involving the pterygoid plates above the level
of the osteotomy line. The preoperative anteroposterior and mediolateral thicknesses
of the PMJ and the length of the medial and lateral pterygoid plates were assessed.
Satisfactory PMD was achieved in all cases and no severe complications were reported,
including vascular, dental, mucosal, or neural damage. The most common PMD was Type
1 (54.3%), followed by Type 2 (40%). Comminuted fracture of the pterygoid plates was
limited to 5.7% of cases, and no Type 4 was detected. A weak correlation was detected
between PMJ thickness and PMD pattern (p = 0.04). No statistically significant correlation
was detected between patients’ age and type of PMD. PMD of Le Fort I maxillary osteotomy
using a Smith spreader and Rowe's disimpaction forceps proved safe, with minimal damage
to the pterygoid plates.
Keywords
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Article info
Publication history
Published online: August 22, 2022
Accepted:
August 17,
2022
Received in revised form:
May 20,
2022
Received:
February 21,
2022
Identification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
