Clinical anatomy of the posterior maxilla pertaining to Le Fort I osteotomy in Thais

Abstract

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. Fifty-five 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 +/- 2.46 mm, 22.51 +/- 3.50 mm, and 7.45 +/- 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 +/- 2.96 mm. The mean widths of the posterior incision of Le Fort I osteotomy at the maxillary tuberosity and PMJ were 20.38 +/- 2.82 mm and 11.60 +/- 1.57 mm. The mean length of the posterior maxilla was 27.18 +/- 2.49 mm. Distances from the greater palatine foramen to the maxillary tuberosity incision and PMJ incision were 1.76 +/- 1.12 mm and 3.59 +/- 1.40 mm. The mean angle between the descending palatine canal and the hard palate was 57.33 +/- 4.54 degrees . 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.

Reproducibility of Linear Measurements Performed with 3-D Cone Beam Computed Tomography: Scan Reconstructions in Region of Pterygomaxillary Junction

“…The presence of synostosis at the pterygomaxillary fissure changes its hardness. The failure of exact separation of the pterygomaxillary fissure was presented by Cheung et al [16]. They confirmed the 12% rate of occurrence of synostosis in their population group [16].…”

“…The failure of exact separation of the pterygomaxillary fissure was presented by Cheung et al [16]. They confirmed the 12% rate of occurrence of synostosis in their population group [16]. Preoperative radiography is currently obligatory.…”

“…It has been evaluated by direct inspection [14][15][16][17][18] as well as with 3D CBCT reconstruction images [14,15,18]. However, these programs use different reconstruction algorithms or different methods of measurement, or both.…”

Avaliação de medidas lineares para osteotomia tipo Le Fort I por meio de diferentes programas de imagem utilizando a tomografia computadorizada

“…Desde então diversas modificações foram constantemente sugeridas com variações no desenho da osteotomia e no posicionamento da incisão em tecido mole a fim de facilitar a movimentação espacial da maxila e a estabilidade após seu reposicionamento tendo em vista à manutenção da irrigação dos tecidos ósseos, tecidos moles e dos dentes maxilares (Apinhasmit et al, 2005) (Figura 2.1).…”

“…Casos graves como a perda completa da visão e até mesmo formação de fístulas arteriovenosas foram relatados (Lanigan et al, 1990;Cruz;dos Santos, 2006;Goffinet et al, 2010 (Lanigan et al, 1990;Gauthier et al, 2002;Kramer et al, 2004;Apinhasmit et al, 2005).…”