title: Is Le Fort I Osteotomy Associated With Maxillary Sinusitis?
abstract: OBJECTIVE
  The purpose of the present study was to investigate the association between Le Fort I osteotomy and the anatomic, radiologic, and symptomatic modifications of the maxillary sinus.
  
  
  METHODS
  Subjects who had undergone Le Fort I osteotomy from January 2008 to December 2013 were enrolled in a retrospective cohort study. The eligibility criteria were the availability of a cone beam computed tomography (CBCT) scan taken before and 12 to 24 months after the procedure. The exclusion criteria were the unavailability of CBCT scans, the use of tobacco, and previous orthognathic procedures. The primary predictor variable was time (pre-vs postoperative). The primary outcome variables were the sinus volume, mucosal thickening, iatrogenic alterations in the sinus anatomy, and rhinosinusitis symptoms, evaluated using the Sino-Nasal Outcome 20-item Test (SNOT-20). Descriptive statistics were computed for each variable, and paired analyses were used to compare the pre- and postoperative values.
  
  
  RESULTS
  The data from 64 subjects (mean age 27; 59.4% were female; median follow-up 32.4 months, range 13 to 66 months) were studied. Postoperatively, 1.6% of the sample (0% preoperatively) had moderate-to-severe and 15.6% (3.1% preoperatively) had mild-to-moderate sinusitis symptoms. The rest of the sample presented with mild to no symptoms. The increase in the SNOT scores after surgery was statistically significant (P = .016). Radiologic evidence of postoperative inflammatory processes affecting the paranasal sinuses was found in 27.3% of the sinuses (9.4% preoperatively). The postoperative Lund-Mackay scores were significantly greater (P = .0005). A 19% decrease was found in the mean postoperative sinus volume, with a 37% incidence of iatrogenic injury.
  
  
  CONCLUSIONS
  The study results indicate that Le Fort I osteotomies can have an important impact on sinus health. The postoperative radiologic evidence of maxillary sinus inflammatory processes and the incidence of rhinosinusitis symptoms and iatrogenic damage in these patients have led us to conclude that CBCT scans and the SNOT-20 questionnaire should be used routinely during postoperative monitoring. Larger long-term studies are warranted to clarify the postoperative outcomes and complications.
authors.affiliation: Professor and Chief, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Nocini
authors.affiliation: Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Agostino
authors.affiliation: Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy. Electronic address: lorenzo.trevisiol@univr.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Trevisiol
authors.affiliation: Maxillo-Facial Surgeon, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Favero
authors.affiliation: Maxillo-Facial Surgeon, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Pessina
authors.affiliation: Assistant Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Procacci
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000453:epidemiology; D006801:Humans; D007049:Iatrogenic Disease; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000473:pathology; D015523:Maxillary Sinusitis / Q000453:epidemiology*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000473:pathology; D019340:Osteotomy, Le Fort / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012220:Rhinitis / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult