ALTERNATIVE APPROACHES TO PTERYGOMAXILLARY SEPARATION

Pterygoid plate fractures, resulting from the pterygomaxillary separat ion in a Le Fort I osteotomy, may be associated with untoward fracture s that extend to the base of the skull and orbit and which can lead to rare but significant complications. Five alternative approaches to th e pterygomaxillary dysjunction were studied in 50 fresh cadavers. The results of this study show that the use of a curved Obwegeser osteotom e to achieve the pterygomaxillary dysjunction should be abandoned, as it leads to an unacceptably high incidence of high-level pterygoid pla te fractures at, or near, the base of the skull. The best results were obtained with a Stryker(R) micro-oscillating saw.