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  • Title: [Endoscopically-assisted LeFort I osteotomy in distraction procedures of the maxilla].
    Author: Wiltfang J, Kessler P, Neukam FW.
    Journal: Mund Kiefer Gesichtschir; 2002 Jul; 6(4):231-5. PubMed ID: 12242931.
    Abstract:
    PURPOSE: The purpose of this study was to demonstrate the feasibility of combining a minimally invasive endoscopic approach to the maxilla with transverse and sagittal distraction procedures. MATERIALS AND METHODS: Four human cadavers were used for training of a minimally invasive access to the maxilla to perform an endoscopically assisted Le Fort I osteotomy, before this technique was applied in three patients with transverse and sagittal growth deficits of the maxilla. Access to the maxilla was gained through a small mucosa incision in the vestibule to create a visualization port to the maxillary sinus through a bur hole. Landmarks were identified through the endoscope before a Le Fort I osteotomy was performed using straight and angulated chisels of different form and angulation. In two patients, the maxilla was split sagittally to perform a transverse maxillary expansion. In one patient, a buried distractor was applied close to the piriform aperture to correct a sagittal growth deficit in a hypoplastic maxilla. RESULTS: The endoscopic exposure of the maxillary sinus walls from within the sinus, the accurate identification of landmarks, and the creation of a Le Fort I osteotomy was achieved in all cases. Distractor application close to the piriform aperture rendered good stability. CONCLUSION: The results of these case reports indicate that the endoscopic approach to the maxillary sinus allows excellent exposure of the sinus walls to perform an endoscopically assisted Le Fort I osteotomy. The combination of endoscopy and osteodistraction supports the trend toward minimally invasive, less traumatic surgical procedures, especially in individuals still growing.
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