Abstract
Nasal septum (Obwegeser) osteotome is a basic instrument used for separating the nasal septum and maxilla during Le Fort I osteotomy. If this instrument is placed too high or tilted into the nasal cavity, sphenoid sinus and various adjacent vital structures may be damaged and serious bleeding, neurological complications, or blindness or even death may occur. The aim of this study is to determine the margin of safety for damaging the sphenoid sinus and the adjacent structures with nasal septum osteotome in the young adults: 49 male and 51 female patients between 15 and 25 ages who required a Cone Beam Computed Tomography (CBCT) examination as part of their routine examination. In the study sample consisting of CBCT images, the aimed surgical line, the line between spina nasalis anterior and vomer and the base of sphenoid sinus (undesired line), and tilt angle between surgical and undesirable lines were measured. As the primary outcome of this study, margin of safety for damaging the sphenoid sinus and adjacent vital structures with nasal septum osteotome during Le Fort surgeries in young adults recommended as 5 mm and 120. For this reason the importance of planning with preoperative CBCT before Le Fort I osteotomies has been revealed.
Highlights
Orthognathic treatment is used worldwide to correct severe dentofacial anomalies with the benefits and risks [1]
The aim of this study is to determine the margin of safety for damaging the sphenoid sinus and the adjacent structures with nasal septum osteotome in the young adults
In the study sample consisting of Cone Beam Computed Tomography (CBCT) images of patients, two lines and 1 angle were described and prepared as listed: Figure 1: Linear and angular measurements
Summary
Orthognathic treatment is used worldwide to correct severe dentofacial anomalies with the benefits and risks [1]. Orthognathic surgery has many expected and unexpected complications that cause harm to the patient, occurring either intraoperatively or early or late postoperatively. Some of them are related to nature of surgery and some of them belong to general anesthesia procedures. There are some various rare but severe or life-threating complications [2, 3]. One of major complications is extension of fractures to the pterygoid plate, sphenoid bone, and skull base. It was found to be the cause for devastating complications such as blindness, major bleeding, or even death [4]
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