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.