title: Three-dimensional finite element model to predict patterns of pterygomaxillary dysjunction during Le Fort I osteotomy.
abstract: The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction. The pterygomaxillary dysjunction patterns predicted by the 3D-FEA models of pterygomaxillary dysjunction were classified into three categories and compared to the pterygomaxillary dysjunction patterns observed in the postoperative 3D-CT images. Extension of the cutting line was also simulated using the 3D-FEA models to predict the risk and position of pterygoid process fracture. The rate of agreement between the predicted pterygomaxillary dysjunction patterns and those observed in the postoperative 3D-CT images was 87.0% (κ coefficient 0.79). The predicted incidence of pterygoid process fracture was higher for cutting lines that extended to the pterygomaxillary junction than for conventional cutting lines (odds ratio 4.75; P<0.0001). 3D-FEA can be used to predict pterygomaxillary dysjunction patterns during LFI-non-COSep and provides useful information for selecting safer procedures during LFI-non-COSep.
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan; Department of Oral and Maxillofacial Surgery, Hekinan Municipal Hospital, Hekinan, Aichi, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kuroyanagi
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan; Department of Oral and Maxillofacial Surgery, Inazawa Municipal Hospital, Inazawa, Aichi, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan. Electronic address: hitomiya@dpc.agu.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Miyachi
authors.affiliation: Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Aichi Gakuin Dental Hospital, Nagoya, Aichi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shimozato
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008437:Maxilla / Q000503:physiopathology* / Q000601:surgery*; D019340:Osteotomy, Le Fort; D011237:Predictive Value of Tests; D011378:Prognathism / Q000601:surgery*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012307:Risk Factors; D012984:Software; D013100:Sphenoid Bone / Q000503:physiopathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Le Fort I osteotomy; complication; finite element analysis; orthognathic surgery; pterygoid process fracture