Is Osteotome Type Associated With Lateral Nasal Wall Separation and Nasal Mucosal Integrity in Le Fort I Osteotomy?

[BACKGROUND] Le Fort I maxillary osteotomy involves surgical manipulation near critical anatomical structures, including the lateral nasal wall (LNW), which may lead to complications such as improper bone separation and nasal mucosal perforation.

[PURPOSE] The purpose of this study was to evaluate the association between osteotome type and LNW separation and nasal mucosal integrity.

[STUDY DESIGN, SETTING, AND SAMPLE] This unblinded randomized study included subjects undergoing bimaxillary orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Bezmialem Vakif University, between 2023 and 2024. Subjects with cleft lip/palate, a history of orthognathic surgery, or previous rhinoplasty were excluded.

[PREDICTOR VARIABLE] The predictor variable was the type of osteotome used for LNW osteotomy. Subjects were randomized to undergo LNW osteotomy using either a blade osteotome or a single-guarded osteotome.

[OUTCOME VARIABLES] The primary outcome variable was LNW separation type, categorized as type 1 (separation from the osteotomy line), type 2 (separation 2 to 4 mm above the osteotomy line), and type 3 (separation ≥4 mm above the osteotomy line). Type 1 separations were considered favorable, whereas type 2 and type 3 separations were considered unfavorable. The secondary outcome variable was nasal mucosal status coded as perforated or not perforated.

[COVARIATES] The covariates were LNW length, LNW angle, age, and sex.

[ANALYSES] Continuous variables were analyzed using the independent samples t test or Mann-Whitney U test. Categorical variables were analyzed using the χ test or Fisher's exact test. A P value of ≤ 0.05 was considered statistically significant.

[RESULTS] The sample consisted of 46 subjects who completed the study (median age, 23 years; interquartile range [IQR], 20 to 27; 31 females [67.4%] and 15 males [32.6%]). LNW type 1 separation was observed in 46 LNW (100.0%) in the blade osteotome group and in 40 LNW (87.0%) in the single-guarded osteotome group (P = .026). Nasal mucosal perforation occurred in 0 subjects (0.0%) in the blade osteotome group and in seven subjects (15.2%) in the single-guarded osteotome group (P = .012). LNW separation type was significantly associated with nasal mucosal perforation (P < .001).

[CONCLUSIONS AND RELEVANCE] The use of a blade osteotome resulted in favorable LNW separation patterns, suggesting improved surgical control during Le Fort I osteotomy. These findings suggest that blade osteotomes may help preserve sinonasal anatomy and mucosal integrity during Le Fort I osteotomy.