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Relevant Surgical Anatomy of Pterygomaxillary Dysjunction in Le Fort III Osteotomy

Orra, Susan M.D.; Tierney, William S. M.D., M.S.; Capone, Avery C. M.D.; Gharb, Bahar Bassiri M.D., Ph.D.; Papay, Frank A. M.D.; Doumit, Gaby M.D., M.Sc.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 701–709
doi: 10.1097/PRS.0000000000003084
Pediatric/Craniofacial: Original Articles

Background: Le Fort III osteotomy represents the foundation of surgical correction for midface hypoplasia. One serious complication of Le Fort III osteotomy is severing the internal maxillary artery or its branches during osteotome advancement for pterygomaxillary dysjunction. This study sought to characterize the relevant surgical anatomy of the infratemporal fossa and of the internal maxillary artery as it enters the pterygomaxillary fissure.

Methods: Bilateral midface dissections were performed on 15 fresh, normocephalic adult cadavers (30 hemifaces). Four superficial anatomical measurements were performed on the surface of the face, followed by 10 deep measurements of the internal maxillary artery and its branches relative to the infratemporal fossa and its surrounding bony landmarks.

Results: The distance from the anterosuperior aspect of the zygomatic arch to the sphenopalatine artery entering the pterygomaxillary fissure was 38.9 ± 3.2 mm. The distance from the alveolar process of the maxillary bone to the sphenopalatine artery entry into the pterygomaxillary fissure was 30.3 ± 6.4 mm. The zygomaticofrontal suture was 43.4 ± 8.5 mm from the sphenopalatine artery entry into the pterygomaxillary fissure, 58.8 ± 8.0 mm from the pterygomaxillary junction, and 74.9 ± 6.5 mm from the maxillary alveolar process. The distance from the sphenopalatine artery to the posterior superior alveolar artery was 14.4 ± 4.1 mm. Elevation of the internal maxillary artery from the lateral pterygoid plate was 5.8 ± 2.5 mm.

Conclusion: This study characterizes the surgical anatomy of the infratemporal fossa in the context of Le Fort III osteotomies and their associated pterygomaxillary dysjunctions.

Cleveland, Ohio; and Montreal, Quebec, Canada

From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.

Received for publication October 31, 2015; accepted July 14, 2016.

The first two authors should be considered co–first authors.

Presented at the 15th International Congress of the International Society of Craniofacial Surgery, in Jackson Hole, Wyoming, September 10 through 14, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Gaby Doumit, M.D., M.Sc., 100 Chemin Rockland, Suite 110, Ville Mont-Royal, Quebec H3P 2V9, Canada,

©2017American Society of Plastic Surgeons