Removal of Large Complex Odontoma Using Le Fort I Osteotomy

Abstract

We read with great interest the article by Korpi et al on “Removal of Large Complex Odontoma Using Le Fort I Osteotomy,” 1 Korpi J.T. Kainulainen V.T. Sandor G.K. et al. Removal of large complex odontoma using Le Fort I osteotomy. J Oral Maxillofac Surg. 2009; 67: 2018 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar and we would like to share our personal experience regarding the use of Le Fort I-type osteotomy as a surgical approach for removal of large maxillary lesions. First, we believe that this technique is reserved not only to posteriorly located maxillary lesions as reported by the authors, but equally for removal of lesions involving 1 or more maxillary walls. Second, the “panoramic” view of both the maxillary sinus and the nasal cavity makes this approach incontestably unique not only for removal of large lesions but also to access specific not otherwise easily viewable anatomical regions, such as the lacrymal recess of the maxillary sinus, the inferior part of the orbital floor, the posterior palatine vessels and nerves, and the pterygomaxillary fossa. Third, this technique allows a safe and circumferential control of the entire lesion, thus guaranteeing its in toto removal, avoiding “blind” damage of adjacent vital structures (ie, infraorbital and palatine vessels and nerves, etc). For these reasons, we have also been using this technique for removal of either solitary large odontogenic keratocysts or multiple odontogenic keratocysts as found in patients suffering from basal cell nevus syndrome (Gorlin-Goltz syndrome) (Figure 1, Figure 2), given that these cysts are locally aggressive and known to have a high rate of recurrence. 2 Scolozzi P. Lombardi T. Jaques B. Le Fort I type osteotomy and mandibular sagittal osteotomy as a surgical approach for removal of jaw cysts. J Oral Maxillofac Surg. 2007; 65: 1419 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In our experience, this is an optimal treatment capable of allowing the whole removal of the cyst wall, which is the seat of satellite cysts and rests on the odontogenic epithelium responsible for late recurrence. Since the introduction of this technique in our department 10 years ago, 12 patients underwent removal of 1 or more odontogenic keratocysts by a Le Fort I osteotomy. The longest follow-up is now 7 years; the shortest is 1 year, and none of the patients developed recurrences. In replyJournal of Oral and Maxillofacial SurgeryVol. 68Issue 4PreviewIt is always heartening to read that surgeons in different parts of the world can independently come to the same conclusions about the great utility of a surgical approach that can be used in the treatment of both tumors and orthognathic problems. Such is the case with the Le Fort I maxillary osteotomy. Here we see the Le Fort I as a procedure that was initially described by Cheevers as a means to remove maxillary tumors.1 Later the Le Fort I osteotomy was popularized as an important osteotomy technique in orthognathic surgery. Full-Text PDF