Easily manoeuvrable osteotome for pterygomaxillary disjunction

Abstract

Fig. 1. Swan’s neck osteotome. The curved handle accommodates the cheek. This unique and chunky shape is sometimes difficult to handle. n Le Fort I osteotomy, secure disjunction of the pterygomaxllary suture is essential to mobilise the maxilla and avoid omplications. For desirable disjunction, the vector of force hould be transmitted from a posterolateral to an anteromeial direction, but this is often difficult even with a curved steotome, because the oral commissure is blocked. Reckess attempts to split the suture under difficult circumstances an produce undesirable fractures of the palatal bone, the axillary tuberosity, and the pterygoid plate, occasionally ccompanied by severe haemorrhage.1 To overcome these problems, a specially-designed swan’s eck osteotome is commercially available (Fig. 1).2 This has unique loop that resembles a swan’s neck to accommoate the cheek. Under clinical conditions, however, this is not lways easy to handle because the range of possible angular djustments is narrow (particularly in cases of deep pteryomaxillary sutures) and the force transmitted to the cutting dge will decrease at the loop, which acts as a buffer. The ncision into the mucous membrane also has to be continued ore distally and the periosteum raised widely to insert this hunky instrument, or the periosteum will be torn and the uccal fat-pad will be exposed. We have developed a simle osteotome to enable easy access to the pterygomaxillary uture and allow direct transmission of the force without any eduction (Figs. 2 and 3). The top blade is parallel to the grip to transmit the force in he same direction, with a slight curve to the cutting edge to