Pyramidal osseous release around the descending palatine artery: A surgical technique

Abstract

A frequent site of osseous mechanical obstruction during Le Fort I maxillary impactions is the area of the descending palatine artery as it enters the tuberosity region. A surgical procedure is outlined, explaining how this area can be relieved without compromising the palatal blood supply. During a Le Fort I downfracture, the area around the descending palatine vessels is often not surgically cut. This region of fusion between the posterior/medial maxillary antrum, palatal bones, and pterygoid plates is fractured rather than osteotomized. Because of the intrinsic strength of the bone in this region, a high fracture commonly occurs. When the maxilla is impacted in a cephalad direction, there is often interference in this site preventing superior repositioning. Attempts to remove bone directly around the vessel are difficult and can lead to severing of the palatine artery. The surgeon, in an attempt to avoid vascular injury, may inadvertently leave bony contact posterior to the artery. This contact produces a deflection that causes rotation of the condyle inferiorposteriorly as the maxillary osteotomy is closed anteriorly. This can lead to immediate posfixation anterior open bite, as the condyle settles back into the fossa. To avoid this possibility, a surgical technique is described to remove posterior osseous interferences during Le Fort I osteotomies without violating the palatine vessels.