Endoscopically Assisted Le Fort I Osteotomy to Correct Transverse and Sagittal Discrepancies of the Maxilla

Purpose: The purpose of this report was to show the feasibility of the combination of a minimally invasive endoscopic approach to the maxilla with transverse and sagittal distraction procedures. Materials and Methods: Four human cadavers were used for training of a minimally invasive access to the maxilla to perform a endoscopically assisted Le Fort I osteotomy, before this technique was applied in 3 patients with transverse and sagittal growth deficits of the maxilla. Access to the maxilla was gained through a small mucosa incision in the vestibule to create a visualization port to the maxillary sinus through a bur hole. Landmarks were identified through the endoscope before a Le Fort I osteotomy was performed using chisels of different shapes and angulations. In 2 patients the maxilla was split sagittally to perform a transverse maxillary expansion; in 1 patient, a buried distractor was applied close to the piriform aperture to correct a sagittal growth deficit in a hypoplastic maxilla. Results: Endoscopic exposure of the maxillary sinus walls from within the sinus, the accurate identification of landmarks, and the creation of a Le Fort I osteotomy were achieved in all cases. Distractor application close to the piriform aperture rendered good stability. Conclusion: The results of these cases indicate that the endoscopic approach to the maxillary sinus allows excellent exposure of the sinus walls to perform a endscopically assisted Le Fort I osteotomy. The combination of endoscopy and osteodistraction processes supports the tendency to perform minimally invasive, less-traumatizing surgical procedures, especially in individuals who are still growing.