Tuberosity Separation in Le Fort Ⅰ Osteotomy Using Ultrasonic Bone Cutting Instrument

The most serious complications of standard Le Fort Ⅰ osteotomy occur as a consequence of pterygomaxillary separation. To reduce the risk of unexpected fracture during pterygomaxillary separation, Trimble et al. reported a modification of pterygoid plate separation while performing low-level maxillary osteotomy. On the other hand, recently, there have been some reports that piezoelectric osteotomy could reduce blood loss and inferior alveolar nerve injury during orthognathic surgery. To reduce the complications following pterygomaxillary separation, we have performed Le Fort Ⅰ osteotomy with tuberosity separation using an ultrasonic bone cutting instrument and customized curved osteotome. Thirty-six patients （15 males and 21 females） underwent Le Fort Ⅰ osteotomy with tuberosity separation at the Department of Oral Surgery, Kanagawa Dental University, Yokohama Clinic from October 2017 to March 2019. The mean operation time and blood loss were 213.4±45.3 （mean±SD）min and 155.8±87.2 （mean±SD）ml, respectively. Computed tomography images taken one year after surgery showed a continuous radiopaque area between the pterygoid plate and maxillary tuberosity. The postoperative stability of the maxilla was excellent in all cases. These results show that tuberosity separation in Le Fort Ⅰ osteotomy using an ultrasonic bone cutting instrument and customized curved osteotome is an efficacious and safe surgical technique.