Piezo-surgical pterygoid plate horizontal osteotomy (PS-PPHO): a novel alternative to the classic vertical pterygomaxillary split in LeFort I osteotomy - clinical experience in a tertiary center.

BACKGROUND: The pterygomaxillary disjunction remains one of the most technically demanding and risk-prone steps in Le Fort I osteotomy, with potential for uncontrolled pterygoid fractures and severe hemorrhage. To enhance safety and control, we introduced the piezo-surgical pterygoid plate horizontal osteotomy (PS-PPHO), a novel alternative to the conventional blind vertical pterygo-maxillary split.

METHODS: A retrospective observational cohort study was conducted at a tertiary referral center between 2008 and 2020, including 243 consecutive patients who underwent Le Fort I osteotomy or surgically assisted rapid maxillary expansion (SARME) using PS-PPHO. Demographic, procedural, and postoperative data were collected from institutional records and analyzed descriptively. The study was conducted in accordance with the Declaration of Helsinki and reported according to the STROBE guidelines.

RESULTS: All procedures were completed as planned without intraoperative conversion to conventional instruments. No major complications such as life-threatening hemorrhage, cranial base injury, or ophthalmic events occurred. Minor postoperative events were limited to mild epistaxis in 3.7% of patients and transient infraorbital numbness in 12.9%, both resolving spontaneously. Palatal sensory disturbance after SARME occurred in 5.3% of cases and resolved during follow-up.

CONCLUSION: PS-PPHO provides a controlled and direct approach to the pterygomaxillary junction. In this large single-center retrospective series, the technique was feasible and was associated with a low incidence of reported complications. In the absence of a conventional control group, no conclusions regarding comparative safety or superiority can be drawn. Further comparative studies are required to evaluate its relative safety and clinical outcomes.