Anatomy and development of the pterygopalatomaxillary region, studied in relation to Le Fort osteotomies.

An understanding of the anatomy and postnatal development of the pterygomaxillary region is needed as a basis for timing and completion of Le Fort osteotomies. The present study included a macroscopic and microscopic study of human skull and autopsy material, both materials representing different developmental stages. Finally, Le Fort I procedures were completed on adult cadavers and the pterygomaxillary region studied histologically. The skull material demonstrated an increasing association between the palatine bone and adjacent bones. Disarticulation was possible only in the infantile period; in the late juvenile and the adolescent stages, disarticulation was accompanied by fractures of the heavily interdigitated osseous surfaces. The histological studies confirmed the marked complexity of the suture, and our findings suggest that the palatine bone acts as a buffer between these areas with their differing intrinsic growth patterns. The remodeling processes in the area seem to reflect different functional demands of the bony pharynx and the maxillary complex. These findings, in conjunction with the significant variations in the gross anatomy of the pterygomaxillary area combined with the location of the actual osteotomy in simulated Le Fort I procedures, force consideration of placement of the posterior osteotomy through the maxillary sinus rather than through the pterygomaxillary fissure in adults. If Le Fort procedures are to be completed in children, probable interference in facial growth is of major concern. Therefore the timing of Le Fort procedures before adolescence must be reconsidered.