Bilge Suheyb, Kaba Yusuf Nuri, Demirbas Ahmet Emin, Kütük Nükhet, Kiliç Erdem, Alkan Alper
Assistant Professor, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
Assistant Professor, Department of Oral and Maxillofacial Surgery, Erciyes University Faculty of Dentistry, Kayseri, Turkey.
J Oral Maxillofac Surg. 2020 Oct;78(10):1820-1831. doi: 10.1016/j.joms.2020.06.003. Epub 2020 Jun 14.
Pterygomaxillary separation (PMS) is considered the main reason for serious complications associated with Le Fort I osteotomy. The aim of this study was to evaluate whether a piezo surgery, ultrasonic bone scalpel, or conventional bur used in Le Fort I osteotomy has an influence on PMS patterns.
Using a retrospective cohort study design, we enrolled a sample composed of patients who underwent orthognathic surgery. The primary predictor variables were the cutting instruments (ultrasonic bone scalpel, piezo surgery, and Lindeman bur) used to perform Le Fort I osteotomy. Other variables were demographic and anatomic parameters. The outcome variable was the type of PMS pattern, classified as follows: type 1, PMS at the pterygomaxillary junction (ideal PMS); type 2, PMS at the greater palatine foramen; type 3, PMS from the posterior wall of the maxillary sinus; and type 4, PMS with lateral or medial pterygoid fracture. Anatomic parameters, that is, the thickness and width of the pterygomaxillary junction and distance of the greater palatine foramen, were measured on preoperative cone-beam computed tomography images. The pattern of PMS was evaluated on postoperative cone-beam computed tomography. Data were analyzed using analysis of variance and the Pearson χ test. P < .05 was considered statistically significant.
This study sample was composed of 96 PMSs in 48 patients. The most common type of PMS was type 1 (58), followed by type 4 (21), type 2 (10), and type 3 (7). A statistically significant relation was found between the cutting instrument and the ideal separation (type 1 PMS) pattern (P = .032), and the highest rate of the ideal separation pattern was seen in the ultrasonic bone scalpel group, at 24 of 32, compared with 22 of 38 in the piezo surgery group and 12 of 26 in the conventional bur group.
According to the study, the ultrasonic bone scalpel is safer than other cutting instruments in terms of the ideal separation of the pterygomaxillary junction.
翼上颌分离（PMS）被认为是与勒福Ⅰ型截骨术相关严重并发症的主要原因。本研究的目的是评估在勒福Ⅰ型截骨术中使用压电手术、超声骨刀或传统牙钻是否会对PMS模式产生影响。
采用回顾性队列研究设计，我们纳入了一组接受正颌手术的患者样本。主要预测变量是用于进行勒福Ⅰ型截骨术的切割器械（超声骨刀、压电手术和林德曼牙钻）。其他变量是人口统计学和解剖学参数。结果变量是PMS模式的类型，分类如下：1型，翼上颌连接处的PMS（理想的PMS）；2型，腭大孔处的PMS；3型，上颌窦后壁的PMS；4型，伴有翼外肌或翼内肌骨折的PMS。在术前锥形束计算机断层扫描图像上测量解剖学参数，即翼上颌连接处的厚度和宽度以及腭大孔的距离。在术后锥形束计算机断层扫描上评估PMS的模式。使用方差分析和Pearson χ检验分析数据。P <.05被认为具有统计学意义。
本研究样本由48例患者中的96处PMS组成。最常见的PMS类型是1型（58处），其次是4型（21处）、2型（10处）和3型（7处）。在切割器械与理想分离（1型PMS）模式之间发现了统计学上的显著关系（P = 0.032），理想分离模式的最高发生率出现在超声骨刀组，32例中有24例，相比之下，压电手术组38例中有22例，传统牙钻组26例中有12例。
根据该研究，就翼上颌连接处的理想分离而言，超声骨刀比其他切割器械更安全。
