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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Rivista Italiana di Chirurgia Maxillo-Facciale 2004 April;15(1):3-8
Endoscopically controlled transnasal approach to maxillary corticotomies for transpalatal distraction osteogenesis
Mommaerts M. Y.
Division of Maxillo-Facial Surgery St. Jan General Hospital, Brugge, Belgium
Aim. Corticotomies for transpalatal osteodistraction at the Le Fort I level are usually performed with a buccal sulcus approach. The aim was to evaluate the feasibility and the morbidity of a transnasal approach with endoscopic control.
Methods. A transnasal approach was developed with entry incisions in the lateral nasal vestibule and in the membranous septum. A standard orthopedic 25° offset view angle straight endoscope was used for illumination and control of the corticotomies. A prospective clinical trial was performed with 20 consecutive patients who underwent transpalatal osteodistraction surgery for non-congenital maxillary transverse hypoplasia between February and October 2003. Demographic data, indications for surgery, technical nuances and postoperative course were recorded.
Results. Endoscopy was necessary to control the completeness of the zygomatic buttress transection and, to a lesser extent, to control the extention of the posterior wall osteotomy. The learning curve was flat, with a decrease in operation time from 190 min to 45 min. Hospitalization length and postoperative morbidity were similar to the conventional approach, except for nasal discharge that was more frequently observed in the experimental group.
Conclusion. The main asset of endocopically controlled transpalatal osteodistraction surgery is patients’ and referring doctors’ positive perception of minimal access surgery.