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Paramedian unilateral Le Fort I osteotomy.

Tauro DP, Uppada UK - Ann Maxillofac Surg (2015 Jan-Jun)

Bottom Line: A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy.This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery.Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis.

View Article: PubMed Central - PubMed

Affiliation: The Taulins Clinic, Centre for Cranio-Maxillofacial and Reconstructive Surgery, Bangalore, India.

ABSTRACT
A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy. This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery. Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view – (a) Design of the paramedian unilateral Le Fort I osteotomy; (b) Unilateral disarticulation of the maxilla; (c) Fixation of the osteotomized unilateral maxilla; (d) Postoperative intraoral view of the patient showing anterior open bite correction
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Figure 2: Intraoperative view – (a) Design of the paramedian unilateral Le Fort I osteotomy; (b) Unilateral disarticulation of the maxilla; (c) Fixation of the osteotomized unilateral maxilla; (d) Postoperative intraoral view of the patient showing anterior open bite correction

Mentions: Under standard general anesthetic operative conditions via a maxillary translabial vestibular approach the maxilla was exposed keeping the incision restricted up to the canine region on the right side just adequate to expose the pyriform aperture. On the right, a 1 cm crestal incision was made distal to the existing right central incisor to facilitate elevation of the mucoperiosteum of the hard palate all the way down to the soft palate junction about 10–12 mm away from the midline. In situations where a full complement of teeth is present the labial, and the palatal mucoperiosteum may be elevated using a gingival crevicular incision both in the labial and palatal aspects. Standard osteotomy cuts were employed to disarticulate the maxilla on the left side and from the nasal septal articulations. On the right a vertical osteotomy cut was made from the lateral limit of the pyriform aperture down to the residual alveolus and was carried out posteriorly to the posterior edge of the hard palate along the floor of the nasal cavity using a guarded osteotome [Figure 2a]. Due caution was exercised to protect the tissues of the nasal floor and the palatal mucoperiosteum using malleable retractors. The maxilla was now completely disarticulated and mobilized using a spreader and a hook [Figure 2b]. The osteotomized unilateral maxilla was now differentially repositioned to occlude with the mandible in the best intercuspation possible by eliminating the bony interferences along the septum and the posterior maxilla. This reasonably favorable occlusal intercuspation was facilitated by an antero-inferior tip of the maxilla by 4–5 mm and a posterior intrusion by 7–8 mm. Fixation was carried out using 1.5 mm stainless steel plates and screws (6 mm) [Figure 2c]. Wound closure was accomplished with 3–0 vicryl sutures after thorough wound debridement and hemostasis [Figure 2d]. A standard extubation protocol and routine postoperative care were followed until discharge. The preoperative and postoperative radiographs of the patient have been illustrated in Figure 3, and the postoperative view of the patient has been illustrated in Figure 4. The Paramedian unilateral Le Fort I osteotomy has been depicted with the help of line diagrams from the nasal and palatal views for easy understanding in Figures 5 and 6.


Paramedian unilateral Le Fort I osteotomy.

Tauro DP, Uppada UK - Ann Maxillofac Surg (2015 Jan-Jun)

Intraoperative view – (a) Design of the paramedian unilateral Le Fort I osteotomy; (b) Unilateral disarticulation of the maxilla; (c) Fixation of the osteotomized unilateral maxilla; (d) Postoperative intraoral view of the patient showing anterior open bite correction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555955&req=5

Figure 2: Intraoperative view – (a) Design of the paramedian unilateral Le Fort I osteotomy; (b) Unilateral disarticulation of the maxilla; (c) Fixation of the osteotomized unilateral maxilla; (d) Postoperative intraoral view of the patient showing anterior open bite correction
Mentions: Under standard general anesthetic operative conditions via a maxillary translabial vestibular approach the maxilla was exposed keeping the incision restricted up to the canine region on the right side just adequate to expose the pyriform aperture. On the right, a 1 cm crestal incision was made distal to the existing right central incisor to facilitate elevation of the mucoperiosteum of the hard palate all the way down to the soft palate junction about 10–12 mm away from the midline. In situations where a full complement of teeth is present the labial, and the palatal mucoperiosteum may be elevated using a gingival crevicular incision both in the labial and palatal aspects. Standard osteotomy cuts were employed to disarticulate the maxilla on the left side and from the nasal septal articulations. On the right a vertical osteotomy cut was made from the lateral limit of the pyriform aperture down to the residual alveolus and was carried out posteriorly to the posterior edge of the hard palate along the floor of the nasal cavity using a guarded osteotome [Figure 2a]. Due caution was exercised to protect the tissues of the nasal floor and the palatal mucoperiosteum using malleable retractors. The maxilla was now completely disarticulated and mobilized using a spreader and a hook [Figure 2b]. The osteotomized unilateral maxilla was now differentially repositioned to occlude with the mandible in the best intercuspation possible by eliminating the bony interferences along the septum and the posterior maxilla. This reasonably favorable occlusal intercuspation was facilitated by an antero-inferior tip of the maxilla by 4–5 mm and a posterior intrusion by 7–8 mm. Fixation was carried out using 1.5 mm stainless steel plates and screws (6 mm) [Figure 2c]. Wound closure was accomplished with 3–0 vicryl sutures after thorough wound debridement and hemostasis [Figure 2d]. A standard extubation protocol and routine postoperative care were followed until discharge. The preoperative and postoperative radiographs of the patient have been illustrated in Figure 3, and the postoperative view of the patient has been illustrated in Figure 4. The Paramedian unilateral Le Fort I osteotomy has been depicted with the help of line diagrams from the nasal and palatal views for easy understanding in Figures 5 and 6.

Bottom Line: A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy.This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery.Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis.

View Article: PubMed Central - PubMed

Affiliation: The Taulins Clinic, Centre for Cranio-Maxillofacial and Reconstructive Surgery, Bangalore, India.

ABSTRACT
A novel maxillary osteotomy is designed which is a technical modification of the standard Le Fort I osteotomy, termed the paramedian unilateral Le Fort I osteotomy. This technique has been used to correct an anterior open bite in a given patient based on the current clinical scenario as described, secondary to post ankylosis surgery. Its use may be extrapolated to various clinical situations to correct occlusal discrepancies including distraction osteogenesis.

No MeSH data available.


Related in: MedlinePlus