Akademik Veri Yönetim Sistemi
Journal of Oral and Maxillofacial Surgery, 2026 (SCI-Expanded, Scopus)
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 χ2 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.