Endoscopically assisted Le Fort I osteotomy.
OBJECTIVE
A new technique of the Le Fort I osteotomy using endoscopic techniques through limited approaches has been evaluated.


METHODS
This technique was first carried out successfully in a study on six cadavers. Thereafter we performed endoscopically assisted Le Fort l osteotomy in two patients.


METHODS
Four vertical incisions were used in the vestibule (paranasally and posteriorly) as approaches. The endoscope allowed direct visualization of the osteotomy of the maxilla including the pterygomaxillary junction. The osteotomies could be accomplished with a straight 4 mm osteotome for medial and lateral antral walls and nasal septum and a curved osteotome for the pterygomaxillary junction.


RESULTS
The procedures were successful. The descending palatal arteries could be preserved in all cases as a result of endoscopic control. Rigid fixation of the downfractured maxillae was carried out using self-drilling titanium screws and plates.


CONCLUSIONS
Endoscopic visualization allowed safe osteotomy of the medial antral wall preserving the descending palatal artery in all cases and hence less bleeding. Postoperative oedema and swelling in the two clinical cases was definitely reduced when compared with the conventional technique. The time needed for these first two clinical cases was approximately 1 h 30 min, i.e., about 30 min more than with the open technique. Further experience and experimental work, and refinements in technique will help to improve this procedure in its clinical application.
Rohner
D
D
Department of Plastic Surgery, Singapore General Hospital, Singapore. dennisrohner@hotmail.com
Yeow
V
V
Hammer
B
B
D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D004487:Edema / Q000517:prevention & control; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D006488:Hemostasis, Surgical; D006801:Humans; D008437:Maxilla / Q000601:surgery*; D008443:Maxillary Sinus / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D009300:Nasal Septum / Q000601:surgery; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D010159:Palate / Q000098:blood supply; D011183:Postoperative Complications / Q000517:prevention & control; D013100:Sphenoid Bone / Q000601:surgery; D013997:Time Factors; D014025:Titanium; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods; D014945:Wound Healing
D014025:Titanium