title: Three-dimensional computed tomographic evaluation of bilateral sagittal split osteotomy lingual fracture line and le fort I pterygomaxillary separation in orthognathic surgery using cadaver heads: ultrasonic osteotome versus conventional saw.
abstract: OBJECTIVE
  The purpose of this study was to observe the quality of the fracture line on the lingual side of the mandible after sagittal split osteotomy and the quality of pterygomaxillary separation after Le Fort I osteotomy using the BoneScalpel ultrasonic osteotome.
  
  
  METHODS
  Bimaxillary procedures, according to the standard protocol, were performed using 10 fresh cadaver heads. The ultrasonic osteotome was used in the study group, and a reciprocating saw was used in the control group. Three-dimensional reconstructions of postoperative computed tomographic scans were obtained. The lingual ramus fracture pattern and the pterygomaxillary separation pattern were observed, classified, and compared. Postoperative dissections of the skulls were performed to assess the integrity of the infra-alveolar nerve and the descending palatine artery.
  
  
  RESULTS
  No significant differences were found in the cutting time of bone between the BoneScalpel and the sagittal saw. Of the sagittal split osteotomies in the study group, 90% showed a good pattern (vertical pattern of fracture line extending to the inferior border of the mandible running behind the mandibular canal) compared with 50% of the sagittal split osteotomies in the control group. Ideal separation of the pterygoid plates without fractures was observed in 80% of the Le Fort I osteotomies in the study group compared with 50% of the osteotomies in the control group. High-level fractures occurred in 30% of cases in the control group compared with none in the study group. The integrities of the infra-alveolar nerve and the descending palatine artery were preserved in all cases.
  
  
  CONCLUSIONS
  Use of the ultrasonic BoneScalpel did not require more time than the conventional method. An improved pattern of lingual fracture lines in mandibular sagittal split osteotomy procedures and the pattern of pterygomaxillary separation in Le Fort I osteotomy procedures were observed.
authors: Department Head, Department of Oral and Maxillofacial Surgery, Clinique du Val de Sambre, Liège, Belgium.
authors: Sophie
authors: S
authors: Dammous
authors: Intern, Department of Oral and Maxillofacial Surgery, Clinique de l'Espérance, Liège, Belgium.
authors: Quentin
authors: Q
authors: Dupont
authors: Department Head, Department of Oral and Maxillofacial Surgery, Clinique de l'Espérance, Liège, Belgium. Electronic address: roland.gilles@skynet.be.
authors: Roland
authors: R
authors: Gilles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000473:pathology; D015519:Bone Density / Q000502:physiology; D002102:Cadaver; D004867:Equipment Design; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008340:Mandibular Nerve / Q000473:pathology; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D009296:Nasal Cavity / Q000473:pathology; D061646:Operative Time; D056948:Orthognathic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D019340:Osteotomy, Le Fort / Q000295:instrumentation* / Q000379:methods; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation* / Q000379:methods; D010159:Palate / Q000098:blood supply; D056739:Pterygopalatine Fossa / Q000000981:diagnostic imaging / Q000601:surgery*; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000601:surgery; D036542:Tomography, Spiral Computed / Q000379:methods*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*