Browse > Article
http://dx.doi.org/10.5125/jkaoms.2022.48.5.292

Sinus mucosal healing pattern according to pterygomaxillary disjunction type after Le Fort I osteotomy  

Jang, Tae-Seok (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Lee, Seung-Woo (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Lee, Baek-Soo (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Shim, Gyujo (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Seon, Suyun (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Ohe, Joo-Young (Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital)
Publication Information
Journal of the Korean Association of Oral and Maxillofacial Surgeons / v.48, no.5, 2022 , pp. 292-296 More about this Journal
Abstract
Objectives: During Le Fort I osteotomy, the separation of the pterygomaxillary junction (PMJ) is a difficult procedure for most surgeons because it is invisible. In this process, damage to the posterior structures constituting the sinus or those adjacent to it, including the maxillary sinus posterior wall and pterygoid plate, may occur. We would like to investigate the effects of this on the inside of the maxillary sinus after surgery and whether there are complications. Materials and Methods: One-hundred patients who underwent Le Fort I osteotomy from 2013 to 2020 using cone-beam computed tomography images were classified into two groups (clean-cut type and fractured type) according to the PMJ cutting pattern. In addition, the mucosal thickness in the maxillary sinus was divided into preoperative, postoperative three months, one year, and the change over the course of surgery was evaluated retrospectively. Results: Of the total 100 cases, the clean-cut type numbered 28 cases and the fractured type totaled 72 cases. Among the fracture types, part of the sinus wall and the pterygoid plate were broken in 69 cases, and the maxillary sinus posterior wall was detached in three cases. There was no statistically significant difference in sinus mucosal thickening between the clean-cut type and fractured type of the PMJ, three months and one year after surgery between the two groups. However, there was a significant difference in sinus mucosal thickness at postoperative one year in the case where a partial detachment of the maxillary sinus posterior wall occurred compared to not. Conclusion: Even if there is some damage to the structures behind the PMJ, it may not be reasonable to spend some time on the PMJ separation process considering the overall postoperative complications, if there is no significant difference inside the sinus, or increased probability of postoperative complications.
Keywords
Maxillary osteotomy; Pterygomaxillary junction; Maxillary sinus; Mucous membrane;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Dadwal H, Shanmugasundaram S, Krishnakumar Raja VB. Preoperative and postoperative CT scan assessment of pterygomaxillary junction in patients undergoing Le Fort I osteotomy: comparison of pterygomaxillary dysjunction technique and trimble techniquea pilot study. J Maxillofac Oral Surg 2015;14:713-9. https://doi.org/10.1007/s12663-014-0720-y   DOI
2 Panou E, Motro M, Ates M, Acar A, Erverdi N. Dimensional changes of maxillary sinuses and pharyngeal airway in class III patients undergoing bimaxillary orthognathic surgery. Angle Orthod 2013;83:824-31. https://doi.org/10.2319/100212-777.1   DOI
3 Joh Y, Park HS, Yang HJ, Hwang SJ. Horizontal change of philtrum after orthognathic surgery in patients with facial asymmetry. Maxillofac Plast Reconstr Surg 2019;41:48. https://doi.org/10.1186/s40902-019-0232-2   DOI
4 Bin LR, Filho LI, Yamashita AL, de Souza Pinto GN, Mendes RA, Ramos AL, et al. How does bimaxillary orthognathic surgery change dimensions of maxillary sinuses and pharyngeal airway space? Angle Orthod 2020;90:715-22. https://doi.org/10.2319/120919-782.1   DOI
5 Chin YP, Leno MB, Dumrongwongsiri S, Chung KH, Lin HH, Lo LJ. The pterygomaxillary junction: an imaging study for surgical information of LeFort I osteotomy. Sci Rep 2017;7:9953. https://doi.org/10.1038/s41598-017-10592-8   DOI
6 Shanbhag S, Karnik P, Shirke P, Shanbhag V. Association between periapical lesions and maxillary sinus mucosal thickening: a retrospective cone-beam computed tomographic study. J Endod 2013;39:853-7. https://doi.org/10.1016/j.joen.2013.04.010   DOI
7 Iwamoto M, Watanabe M, Yamamoto M, Narita M, Kamio T, Takaki T, et al. Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis. Maxillofac Plast Reconstr Surg 2019;41:12. https://doi.org/10.1186/s40902-019-0195-3   DOI