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At least 19 recordsLinked to original sources
PubMed2001

[Evaluation of the process of recovery of dental pulp after Le Fort I osteotomy].

Le Fort I osteotomy has been established by many studies and is generally used, but hypoesthesia of the dental pulp, the most common complication, occurs in almost all patients. As such, we examined dental pulp sensibility, pulpal blood flow, and histological changes, to elucidate the process of functional recovery of dental pulp after Le Fort I osteotomy. Monkeys (Macaca fusucata) were used in this study. The animals underwent Le Fort I osteotomy in their unilateral maxillae. Histological and angiographic examinations were performed to observe the postoperative changes in the maxillae and dental pulp. Postoperative pulpal blood flow was examined using a laser Doppler flowmetry. Postoperative pulpal blood flow, by a laser Doppler flowmetry, and dental pulp sensibility, by electrodiagnostics, in patients who underwent Le Fort I osteotomy, were also examined. Although nerve fibers observed in the dental pulp of the maxilla degenerated and disappeared by one week postoperatively, they reappeared sparsely from two to three months after osteotomy, and there were abundant nerve fibers by one year postoperatively. In the angiographic examination, blood supply to the maxillary dental pulp was maintained throughout the postoperative period. In the examinations of laser Doppler flowmetry and dental pulp electrodiagnostics, ischemia in the dental pulp for three or four days after osteotomy might delay the recovery of dental pulp sensibility. These results suggested that blood flow in dental pulp at three or four days after surgery may affect the recovery of dental pulp sensibility.

Animals↗
PubMed1986

Pterygoid plate fractures caused by the Le Fort I osteotomy.

Le Fort I osteotomies have been carried out on eight cadavers to determine whether pterygomaxillary dysjunction with a curved chisel causes fractures of the pterygoid plates. Fractures occurred on 12 of the 16 sides, were either at the level of the osteotomy cut or near to the base of the skull, and were sometimes multiple. There was no apparent correlation between the presence, type or extent of pterygoid plate fracture and whether or not that side of the osteotomy was completed first.

Adult↗
PubMed1975

A longitudinal study on electrical pulp testing following Le Fort type osteotomy and Le Fort type fracture.

A longitudinal study of electrical pulp testing was carried out in 27 cases, or 53 maxillary halves following Le Fort type fractures and Le Fort type osteotomies. On the average, most teeth required positive responses around 7 months or around 11 months afterwards. The central and lateral incisor teeth demonstrated poor results; only 8 percent and 36 percent responded positively at 8 months, and at 14 months, 23 per cent and 50 per cent, respectively. The overall percentage of responsive teeth was 29 percent at 6 months and 85 percent at 14 months. These results are discussed and compared with those of segmental maxillary osteotomy, together with the value of pulp testing in the diagnosis in fracture and osteotomy.

Adolescent↗
PubMed1977

Quantitation of blood flow after Le Fort I osteotomy.

Le Fort I maxillary osteotomies were performed on ten macaque monkeys. The particle distribution method (nondiffusible radioactive microspheres) was used to quantitate local blood flow before and after surgery. Significant reduction in blood flow to the osteotomized maxillary segment was noted in those animals (group S) where the descending palatine vessels were transected. Those animals in which the vascular pedicle was intact (group I) showed decreased blood flow to the attached gingiva and alveolar bone, but palatal tissue blood flow was unchanged or increased. The results reinforce the precept of the importance of maintaining an adequate nutrient pedicle when performing orthognathic surgical procedures.

Alveolar Process↗
PubMed1987

Anatomy and development of the pterygopalatomaxillary region, studied in relation to Le Fort osteotomies.

An understanding of the anatomy and postnatal development of the pterygomaxillary region is needed as a basis for timing and completion of Le Fort osteotomies. The present study included a macroscopic and microscopic study of human skull and autopsy material, both materials representing different developmental stages. Finally, Le Fort I procedures were completed on adult cadavers and the pterygomaxillary region studied histologically. The skull material demonstrated an increasing association between the palatine bone and adjacent bones. Disarticulation was possible only in the infantile period; in the late juvenile and the adolescent stages, disarticulation was accompanied by fractures of the heavily interdigitated osseous surfaces. The histological studies confirmed the marked complexity of the suture, and our findings suggest that the palatine bone acts as a buffer between these areas with their differing intrinsic growth patterns. The remodeling processes in the area seem to reflect different functional demands of the bony pharynx and the maxillary complex. These findings, in conjunction with the significant variations in the gross anatomy of the pterygomaxillary area combined with the location of the actual osteotomy in simulated Le Fort I procedures, force consideration of placement of the posterior osteotomy through the maxillary sinus rather than through the pterygomaxillary fissure in adults. If Le Fort procedures are to be completed in children, probable interference in facial growth is of major concern. Therefore the timing of Le Fort procedures before adolescence must be reconsidered.

Adolescent↗
PubMed1997

[Augmentation of the maxillary sinus by Le Fort osteotomy in endosseous implantology. A clinical case report].

The authors present a case of sinus floor elevation using Le Fort I osteotomy. They underline that, owing to its peculiarities, this type of intervention is indicated, in their opinion, for sinus floor elevation when both the vertical dimension and possible skeletal discrepancies require modification. They briefly describe the indications, peculiarities and contraindications.

Alveolar Ridge Augmentation↗
PubMed1998

Blindness as a complication of Le Fort osteotomies: role of atypical fracture patterns and distortion of the optic canal.

Blindness in patients suffering maxillofacial trauma is usually caused by optic nerve or optic canal injuries. It is, however, an uncommon complication of facial trauma, with a reported incidence of only 3 to 5 percent. This incidence drops dramatically when fractures are performed in the controlled situation of orthognathic surgery. Given the rarity of ophthalmic complications after traumatic Le Fort I injuries, it is not surprising that few cases have been reported after orthognathic surgery. In this article, three cases of visual loss or skull base injury after elective Le Fort I osteotomy are described. All of these cases were presumably straightforward surgically and were performed by experienced surgeons. The literature is reviewed and the pathomechanics of each injury are experimentally explored in a cadaver model. To determine the presence of increased pressure on the optic nerve, optic canal deformation, or fractures extending to the skull base, two separate experiments were devised. In the first experiment, a pressure transduction system was used to document any significant forces that may be directly transmitted to the contents of the optic canal during pterygomaxillary separation. Then tested was the hypothesis that a stepped or tapered osteotomy will allow for a more predictable pterygomaxillary fracture. One of five cadaver specimens in group 1 demonstrated a transient increase in the right optic canal pressure during down-fracture of the maxilla. This change was less than 10 mmHg, and its duration was less than 5 seconds. The canal pressure returned to baseline with the completion of the fracture. In group 2, there was no documented pressure change with either osteotomy technique. Of note, in group 2, all specimens undergoing standard Le Fort osteotomy demonstrated uncontrolled propagation of the fracture lines superiorly in the pterygoid bones. The uncontrolled and unpredictable nature of pterygomaxillary disjunction may result in the extension of fractures to the skull base or the generation of deforming forces to the optic canal may compress or injure the optic nerve and its circulation. It is proposed that a stepped or tapered osteotomy will generate a more controlled pterygomaxillary separation during orthognathic surgery and may reduce the risk of devastating ophthalmologic complications.

Adolescent↗
PubMed1990

[Le Fort osteotomy. A study of the complications from a review of the literature and from a homogenous series of 50 patients].

Since Wassmund in 1927, the Le Fort I osteotomy became a popular procedure in maxillo-facial surgery. Review of the literature is presented with a series of 50 homogenous patients. The authors show that they are few complications of this operation although theoretically may look numerous. The intra and post-operative haemorrhages are infrequent and never alter the vital prognosis. The bony necrosis disappeared since the last technical improvements. The secondary displacement remains a problem which seems less important actually because of the use of plates and screws, and the improved surgeon's skill. So, the Le Fort I osteotomy become a reliable surgery since indications and technical points are respected.

Adult↗
PubMed2001

A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy.

PURPOSE: The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible and of the infraorbital nerve (ION) after Le Fort I osteotomy, as well as the rate of recovery of sensory function using subjective and objective measures. PATIENTS AND METHODS: Preoperatively and after 1 week, and 1, 3, 6, and 12 months postoperatively, sensibility in the distribution of 36 IONs after Le Fort I osteotomy and 24 IANs after BSSO in 19 patients were investigated by using sharp-blunt testing, 2-point discrimination, electromyographic recording, and thermal sensitivity (Pain and Thermal Sensitivity Test Device [PATH]) tests of the Adelta and C nerve fibers. RESULTS: With conventional clinical sharp-blunt and 2-point discrimination tests, the incidence of temporary impairment was 81% for the ION (29 of 36) and 83% for the IAN (20 of 24). The rate of permanent sensibility disturbance with conventional clinical testing was 6% for the ION and 15% for the IAN. Obvious recovery was found after 1 to 3 months for the ION, but it took 6 to 12 months for the IAN. In contrast, electromyography (EMG) testing showed lower rates of temporary sensory disturbance, namely, 54% (13 of 24) for the ION and 68% (15 of 22) for the IAN. Permanent sensory losses were not found. The results of the EMG test was confirmed by the PATH test. CONCLUSIONS: Objective tests for sensory disturbances show lower rates than the conventional tests. For quality control, preoperative and postoperative measurement and documentation of postoperative recovery of sensation is recommended.

Adolescent↗
PubMed1993

Recovery following orthognathic surgery: mandibular bilateral sagittal split osteotomy and Le Fort I osteotomy.

Thirty-eight patients, who underwent orthognathic surgery, reported their recovery period upon returning to work or school and returning to full activity. Twenty-six patients had isolated bilateral sagittal split osteotomies (BSSO) and 12 had isolated Le Fort I osteotomies (LFI). At 1 to 2 weeks postoperatively, 50% of the BSSO group had returned to work or school while none of the LFI group had returned. By 3 to 4 weeks, 81% of the BSSO group had returned to work or school while nearly one half of the LFI group still had not returned. The BSSO group returned to full activity earlier than the LFI group, although the differences were not statistically significant. Hemoglobin, hematocrit, weight, and vital signs were determined preoperatively and for 6 weeks postoperatively. The LFI group had a larger mean estimated blood loss, length of operation, and weight loss.

Absenteeism↗
PubMed1986

Sensory nerve morbidity following Le Fort I osteotomy.

The Le Fort I osteotomy has been used increasingly frequently in the management of dentofacial deformity since the wide acceptance of the down-fracture technique. The improved access provided by this technique allows movement of the Le Fort I segment in three planes. This paper reviews briefly the neuroanatomy of the area and considers how the surgical technique of Le Fort I osteotomy interferes with the sensory nerve supply. The sensory nerve function in ten patients who underwent Le Fort I osteotomy is reviewed.

Adolescent↗
PubMed1989

Nasal anatomy and maxillary surgery. II. Unfavorable nasolabial esthetics following the Le Fort I osteotomy.

The Le Fort I osteotomy is among the most commonly performed orthognathic surgical procedures for correction of skeletal dysplasias. Numerous authors have described unfavorable nasal and labial changes following maxillary surgery, such as widening of the alar bases of the nose, upturning of the nasal tip, flattening and thinning of the upper lip, and downturning of the commissures of the mouth. These postoperative changes in nasolabial morphology are secondary to alterations in the regional anatomy following skeletal repositioning, cartilaginous resectioning, muscular retraction, and the resultant effects of these procedures on the overlying skin and subcutaneous tissues. In part I of this series a systematic method of evaluation and a detailed anatomic description of the nasolabial region were presented. This paper presents a series of cases with unfavorable nasal changes following Le Fort I osteotomies, analyzes each case in detail, and discusses the possible etiologies. Part III of this series will present techniques for handling of the skeletal, cartilaginous, and musculofascial components of the nasomaxillary region during the Le Fort I procedure to improve nasofacial esthetics and avoid unfavorable results.

Adolescent↗
PubMed1995

Mobility of the osteotomy site following Le Fort I osteotomy stabilized by titanium plate osteosynthesis.

PURPOSE: This study analyzed whether titanium plate osteosynthesis prevents mobility after Le Fort I osteotomy and, if not, how long the osteotomized segment is mobile. PATIENTS AND METHODS: In 10 patients aged 17 to 49 years, three metal bone markers were inserted below and three above the osteotomy during the Le Fort I procedure, each set forming a triangle. The patients were examined at intervals until 1 year postoperatively. At each examination two sets of x-ray stereograms were obtained; one in rest and one with pressure applied to the anterior part of the maxilla. The difference in position of the maxillary segment in relation to the reference segment between the two sets of stereograms, ie, the mobility, could thus be recorded. Findings of 0.4 degrees and 0.2 mm are considered significant. RESULTS: Immediately after surgery mobility in the osteotomy site was found in 7 of the 10 patients. One year postoperatively mobility in the osteotomy site was still found in four patients. CONCLUSION: Titanium plate osteosynthesis does not prevent mobility between the osteotomy segments after Le Fort I osteotomies. The osteotomized segment may remain mobile at least until 12 months after surgery. During this period the impact of the functional matrix may cause migration of the segment.

Adolescent↗
PubMed2003

Intracranial hemorrhage resulting from skull base fracture as a complication of Le Fort III osteotomy.

Various complications of Le Fort osteotomies have been reported. We describe a lethal complication of Le Fort III osteotomy we encountered in a 9-year-old boy with Crouzon syndrome. A standard Le Fort III osteotomy, including pterygomaxillary dysjunction with a curved osteotome and down-fracture manipulation, was performed uneventfully. When the intraoral buccal wound was closed after fixation of the external midface distraction devices, we discovered hemorrhage originating from the right posterior maxillary region. Although it was stopped with pressure on the osteotomized maxilla, the volume of intraoperative blood loss was nearly 2,000 ml. During the observation period in the intensive care unit, the patient suffered brain death, and he died 3 months later. A computed tomography scan obtained the day after surgery revealed vigorous subarachnoid and intraventricular hemorrhage and transverse fracture of the middle cranial fossa. This skull base fracture was believed to result from intraoperative maneuvers, including the pterygomaxillary dysjunction and down-fracture manipulation. We emphasize the risk of intracranial hemorrhage with Le Fort osteotomy and advise discussing this risk with patients and family members during preoperative consultations.

Blood Loss, Surgical↗