“Twist Technique” for Pterygomaxillary Dysjunction in Minimally Invasive Le Fort I Osteotomy

Abstract

To present a new technique for effective, rapid, and safe pterygomaxillary dysjunction in the context of a minimally invasive Le Fort I protocol and to provide the authors' preliminary experience. In total, 1,297 consecutive patients underwent Le Fort I osteotomy as an isolated procedure or in combination with mandibular surgery. In all cases, the "twist technique" was used to downfracture the maxilla. This method achieves pterygomaxillary dysjunction using a frontal approach and a straight osteotome that is driven along the standard Le Fort I horizontal osteotomy toward the pterygomaxillary junction. Downfracture is achieved by inwardly rotating the osteotome fixed at the zygomatic buttress. The studied sample consisted of 820 women and 477 men (mean age, 28.4 years). Mean surgical time of the maxillary procedure was 44 minutes. Mean incision length was 2.8 cm. No significant neurovascular complications or clinically evident iatrogenic fractures occurred. Mean maxillary advancement was 5.5 mm (range, 2.0 to 14.0 mm). Compared with classic pterygomaxillary dysjunction, the twist technique uses a frontal approach and a straight osteotome. This technical modification requires a substantially smaller incision, achieves an immediate effective separation of the maxilla, and enables adequate visualization of the palatine neurovascular bundle. The authors' preliminary experience in 1,297 patients shows the technique's safety and efficacy.