Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization's Central Ethics Review Board and was also approved by the directors of the participating institutions.

Evaluation of factors affecting recovery period in lower lip hypoesthesia after sagittal split ramus osteotomy in mandibular prognathism patients.

PURPOSE: The purpose of this study was to evaluate the factors affecting the recovery period of lower lip hypoesthesia after sagittal split ramus osteotomy (SSRO) in mandibular prognathism patients using multivariate analysis, retrospectively. SUBJECTS AND METHODS: The subjects were 222 patients (444 sides) who underwent bilateral SSRO setback surgery with and without Le Fort I osteotomy. Trigeminal nerve hypoesthesia at the region of the lower lip was assessed bilaterally by the trigeminal somatosensory-evoked potential (TSEP) method pre- and post-operatively. Recovery period was determined as the time when TSEP was first measurable post-operatively. Age, sex, presence or absence of third molars, setback amount and osteotomy type and fixation method were selected as covariates in the multivariate analysis. The factor affecting the recovery period in lower lip hypoesthesia was examined with Cox's proportional hazard regression. RESULTS: Sex and osteotomy fixation method affected the recovery period in lower lip hypoesthesia significantly (P = 0.0132 and P = 0.0394). However, the other factors did not affect the recovery period. CONCLUSION: This study suggested that sex and osteotomy type and fixation method may affect the recovery period in lower lip hypoesthesia after SSRO setback surgery.

Bone regeneration by periosteal elevation using conventional orthodontic wire and uHA/PLLA mesh.

This study evaluated bone regeneration by periosteal elevation using conventional orthodontic wire and an unsintered hydroxyapatite (u-HA)/poly-L-lactic acid (PLLA) mesh in rabbit frontal bone. Thirty two rabbits (12-16 weeks: 2.5-3.0 kg) were used in this study. In the experimental group, 1 week after the mesh was inserted under the periosteal membrane, it was elevated by traction using the mesh connected with wire and two anchor screws. In the control group, the mesh was kept inserted under the periosteal membrane. Four animals were killed in each period in both groups, at 2, 3, 5 and 9 weeks postoperatively. Operated parts in the frontal bone were removed and prepared for radiological and histological assessment. The distance between the mesh and pristine bone (elevation length), the bone area and the expression of BMP-2 were evaluated. The value in the experimental group was significantly higher when compared to the control group (length P < 0.0001, bone area P < 0.0010, BMP-2 P = 0.0015). The BMP-2 labelling index after 3 weeks tended to be the largest in both groups. This study suggests that bone regeneration can be induced by periosteal elevation using a conventional orthodontic wire and an uHA/PLLA mesh.

Comparison of lower lip hypoesthesia between hybrid fixation and conventional fixation following sagittal split ramus osteotomy.

PURPOSE: The purpose of this study was to compare the recovery period of lower lip hypoesthesia between hybrid fixation and conventional fixation using absorbable plates and screw systems following sagittal split ramus osteotomy (SSRO). SUBJECTS AND METHODS: The subjects were 66 patients (132 sides) who underwent bilateral SSRO setback surgery. They were divided into a hybrid fixation group (66 sides, 1 u-HA/PLLA plate and 4 mono-cortical screws and a bi-cortical screw in each side) and a conventional fixation group (66 sides, 1 u-HA/PLLA plate and 4 mono-cortical screws in each side). Trigeminal nerve hypoesthesia at the region of the lower lip was assessed bilaterally by the trigeminal somatosensory-evoked potential (TSEP) method. RESULTS: The mean measurable periods were 8.1 ± 10.4 weeks in the hybrid fixation group, 5.1 ± 11.5 weeks in the conventional group with no significant difference. However, the maximum in the hybrid fixation group was 27 sides at 4 weeks postoperative and in the conventional fixation group was 37 sides at 1 week postoperative, and there was significant difference in the distribution of the measurable period (P < 0.0001). CONCLUSION: This study suggested that additional bi-cortical screws could affect the recovery of lower lip hypoesthesia after SSRO with bent absorbable plate fixation.

Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery.

PURPOSE: The purpose of this study was to evaluate the relationship between lip closing force, occlusal contact area and occlusal force after orthognathic surgery in skeletal Class III patients. SUBJECTS AND METHODS: The subjects consisted of 54 patients (28 female and 26 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces, occlusal contact area and occlusal force were measured pre-operatively, 6 months and 1 year post-operative. RESULTS: Maximum and minimum lip closing forces, occlusal contact area and occlusal force increased with time after surgery, however a significant increase was not found in the occlusal contact area in women. In increased ratio (6 months/pre-operative and 1 year/pre-operative), the maximum lip closing force was significantly correlated with the occlusal contact area (P < 0.0001). CONCLUSIONS: This study suggested that orthognathic surgery could improve the occlusal force, contact area and lip closing force, and an increase ratio in maximum lip closing force was associated with an increased ratio in occlusal contact area.

The time-course change in the lip closing force in Class III malocclusion after orthognathic surgery.

OBJECTIVES: The purpose of this study was to examine the changes with time in lip pressure after orthognathic surgery for skeletal Class III patients. STUDY DESIGN: The subjects consisted of 63 patients (32 female and 31 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces were measured with Lip De Cum(®). The changes with time were compared statistically. RESULTS: The maximum and minimum lip closing force increased time-dependently in men and women after surgery and there were significant differences between men and women with changes with time in the maximum lip closing force (p = 0.0086) and the minimum lip closing force (p = 0.0302). After 1 year, the Class III group maximum lip closing force was significantly smaller than the control group in both men (p < 0.0001) and women (p < 0.0001). CONCLUSIONS: This study suggests that there was significant difference in over time in the lip closing force between men and women in Class III patients. Although the maximum lip closing force increased with time, it did not reach the level of the control group after 1 year.

Evaluation of soft tissue morphologic changes after using the alar base cinch suture in Le Fort I osteotomy in mandibular prognathism with and without asymmetry.

PURPOSE: The purpose of this study was to investigate the effects of alar base cinch suture in Le Fort I osteotomy in mandibular prognathism with and without asymmetry. MATERIAL AND METHODS: Forty patients who underwent Le Fort I osteotomy were divided into an asymmetry group and a symmetry group (n = 20 each). Computed tomography (CT) was taken in all patients before and 1 year after surgery. The CT-3D volume rendering data with Aquarius Net (TeraRecon, Foster City, CA, USA) was reconstructed and the soft tissue was measured as follows, the distance between the bilateral alar base (Alar base width), the distance between the bilateral alar (Alar width), the angles between the FH plane and the line between the bilateral alar base (Alar base angle), the angle between the FH plane and the line between the bilateral alar (Alar angle), the angle between the FH plane and the line between the bilateral corners of the mouth (Lip angle), and the angle between the perpendicular line to the FH plane and the Philtrum (Philtrum angle). RESULTS: Significant differences were observed in the Alar width (P = 0.0448), the Alar angle (P = 0.0044), the Lip angle (P < 0.0001), and the Philtrum angle (P = 0.0057) between before and after surgery in the asymmetry group. CONCLUSIONS: This study suggested that the alar base cinch suture could prevent increases in the alar base width in both groups and help to improve the angle of soft tissue in the asymmetry group, although alar width significantly increases after surgery.

Evaluation of overlapped cortical bone area after modified plate fixation with bent plate in sagittal split ramus osteotomy.

PURPOSE: The purpose of this study was to evaluate bony change in an overlapped cortical bone area at the anterior site of the proximal segment after modified plate fixation with a bent plate in sagittal split ramus osteotomy (SSRO). SUBJECTS AND METHODS: The subjects were 66 patients (132 sides) who underwent bilateral SSRO setback surgery. After the surgery in SSRO, an overlapped area of cortical bone at the anterior site of the proximal segment was not removed to keep the contact area between the proximal and distal segments intact, and was fixed with a bent plate and 4 screws in each side of the mandible. At the posterior site, a 3-7 mm gap was maintained between the proximal and distal segments to prevent inward-rotation of the condylar long axis. Ramus width, lateral cortex width and lateral cortex step angle were assessed in a coronal image immediately after the surgery, and 1-year postoperative by computed tomography (CT). RESULTS: Ramus width after 1-year was significantly larger than that before surgery and smaller than that immediately after surgery in both sides (P < 0.0001). Lateral cortex width after 1-year was significantly larger than the preoperative value and smaller than that immediately after surgery in both sides (P < 0.0001). Lateral cortex angle after 1-year was significantly larger than the preoperative value in both sides (P < 0.0001). CONCLUSION: The above findings suggested that the overlapped cortical bone decreased thickness and the cortical bone step disappeared following favourable bone remodelling after 1-year, even though the cortical bone was not removed at the anterior site of the proximal segment.

Bone regeneration by statin and low-intensity pulsed ultrasound (LIPUS) in rabbit nasal bone.

OBJECTIVES: To compare bone regeneration between local implantation of statin and low-intensity pulsed ultrasound (LIPUS), and the combination of statin with LIPUS in rabbit nasal bone using histological and immunohistochemical methods. STUDY DESIGN: Thirty-two adult male Japanese white rabbits (age: 12-16 weeks, weight: 2.5-3.0 kg) were used in this study. Two bone circular defects (5 mm in diameter) per rabbit were created in the nasal bone while preserving the nasal membrane. The two defects in each rabbit were filled with 2.5 mg/ml simvastatin in 0.2 ml water with an atelocollagen sponge (ACS) and ACS alone respectively. Sixteen rabbits (32 sides) received the LIPUS application; the remaining 16 rabbits (32 sides) did not. Therefore, the subjects composed of 4 groups, namely, (1) LIPUS + ACS + simvastatin (the LAS group), (2) LIPUS + ACS (the LA group), (3) ACS + simvastatin (the AS group) and (4) ACS alone (the A group). Four animals were killed in each period, at 1, 2, 4 and 8 weeks postoperative. The parts that had been operated on were removed and prepared for histological assessment. The expression of BMP-2 and the bone area ratio were evaluated using histological and immunohistochemical methods. RESULTS: Bone square in the LAS group was significantly larger than that in the AS group after 1 (P < 0.0001) and 2 week (P = 0.0113). The bone square in the LA group was significantly larger than that in the A group after 1 (P < 0.0001) and 2 weeks (P = 0.0090). However, there was no significant difference between the LAS and LA groups. In the number of cells that stained positive for BMP-2, the LAS group was significantly larger than that in the AS group after 1 (P < 0.0001) and 2 weeks (P = 0.0113). CONCLUSION: This study suggests that bone regeneration can be promoted by LIPUS alone and statin alone, respectively. However the combination use of LIPUS with statin does not differ from LIPUS alone or statin alone.

Skeletal stability after mandibular setback surgery: comparison between the hybrid technique for fixation and the conventional plate fixation using an absorbable plate and screws.

PURPOSE: The purpose of this study was to compare the temporal changes in condylar long axis and skeletal stability after sagittal split ramus osteotomy (SSRO) with the hybrid fixation technique and the conventional plate fixation. PATIENTS AND METHODS: Of 44 Japanese patients diagnosed with mandibular prognathism, 22 underwent SSRO with the conventional plate fixation (1 u-HA/PLLA plate and 4 monocortical screws in each side) and 22 underwent SSRO with a hybrid fixation technique (1 u-HA/PLLA plate and 4 monocortical screws and bicortical screw in each side). The temporal changes in condylar long axis and skeletal stability were assessed by axial, frontal, and lateral cephalograms. After surgery, breakage of the plate and screws was checked by 3-dimensional computed tomography (3DCT). RESULTS: Although there was a significant difference between the groups regarding Me-Ag in T1 (P = 0.0138), there were no significant differences between the groups for the other measurements in lateral, frontal and axial cephalometric analysis in each time interval. In two cases, 4 sides in the conventional plate fixation group, failure of the absorbable plate was found by 3DCT. However, there was no breakage in the hybrid fixation group. CONCLUSION: This study suggested that there were no significant differences in the postoperative temporal changes between the two groups in mandibular setback surgery.

Comparison between unsintered hydroxyapatite/poly-L-lactic acid mesh and titanium mesh in bone regeneration of rabbit mandible.

PURPOSE: The purpose of this study was to compare the bone regenerative capability of using unsintered hydroxyapatite/poly-L-lactic acid (uHA/PLLA) mesh and titanium mesh. MATERIALS AND METHODS: Adult male white rabbits (n = 24) were divided into 2 groups. After incising along the mandible, 3 × 5 mm bone defects were made in both sides and covered by an uHA/PLLA mesh (n = 12) or a titanium mesh (n = 12) on the right side but no mesh on the left side (n = 12). The rabbits were sacrificed at 1, 2, and 4 weeks postoperatively, and formalin-fixed specimens were embedded in acrylic resin. The specimens were stained with hematoxylin and eosin. For immunohistochemical analysis, the specimens were treated with BMP-2. RESULTS: The titanium group and uHA/PLLA group were significantly larger than the control group regarding the bone area ratio postoperatively at 2 and 4 weeks. However, there were no significant differences between the uHA/PLLA group and titanium group regarding the BMP-2. CONCLUSIONS: This study suggested that the uHA/PLLA mesh could increase new bone formation more than the absence of a mesh in bone defects. However, there was no significant difference between uHA/PLLA mesh and the titanium mesh in bone augmentation.

Assessment of bone healing and hypoesthesia in the upper lip after Le Fort I osteotomy with self-setting α-tricalcium phosphate and absorbable plates.

PURPOSE: The purpose of this study was to evaluate hypoesthesia of the upper lip and bone formation using self-setting α-tricalcium phosphate (Biopex(®)) between the segments following Le Fort I osteotomy with bent absorbable plate fixation. SUBJECTS AND METHODS: The subjects were 47 patients (94 sides) who underwent Le Fort I osteotomy with and without mandibular osteotomy. They were divided into a Biopex(®) group (48 sides) and a control group (46 sides). The Biopex(®) was inserted into the anterior part of the gap between the segments in the Biopex(®) group. Trigeminal nerve hypoesthesia at the region of the upper lip was assessed bilaterally by the trigeminal somatosensory-evoked potential (TSEP) method. The area of the Biopex(®) at the anterior part in the maxilla was assessed immediately after surgery and 1 year postoperatively by computed tomography (CT). RESULTS: The mean measurable period and standard deviation were 13.2 ± 18.5 weeks in the control group, 14.5 ± 17.9 weeks in the Biopex(®) group, and there was no significant difference in TSEP. The area of the Biopex(®) after 1 year was significantly smaller than that immediately after surgery (right side: P = 0.0024, left side: P = 0.0001) and bone defects between the segments could not be found in the Biopex(®) group. In the control group, although the areas of bone defect after 1 year were significantly smaller than that immediately after surgery on the right side (P = 0.0133) and left side (P = 0.0469) in the frontal view, complete healing of the bone defects could be seen in 12 of 46 sides after 1 year. CONCLUSION: This study suggested that inserting Biopex(®) in the gap between the maxillary segments was useful for new bone formation and it did not prevent the recovery of upper lip hypoesthesia after Le Fort I osteotomy with absorbable plate fixation.

An odontoma found in the wake of maxillary sinusitis onset.

Sinusitis of dental origin is a relatively frequent entity, and odontomas are considered to be the most common odontogenic tumors of the oral cavity. Eruption and infection of odontomas are extremely rare. Here, we report an interesting case where odontoma was found in the wake of the maxillary sinusitis onset.

A hypothesis on the desired postoperative position of the condyle in orthognathic surgery: a review.

It is very important to clarify the relationship between a dentofacial structure and a temporomandibular joint (TMJ) structure in orthognathic surgery. Recently, it was reported that the skeletal and occlusal patterns were associated with the TMJ morphology, including the disk position. In orthognathic surgery, some surgeons state that alterations in the condylar position from surgery can lead to malocclusion associated with the risk of early relapse, and also favor the development of temporomandibular disorders. For these reasons, several positioning devices have been proposed and applied, but now there is no scientific evidence to support the use of condylar positioning devices. There are some reasons why scientific evidence cannot be obtained; however, it also includes the question of whether the preoperative position of the condyle is the desired postoperative position. The purpose of this study was to verify the desired condylar position in orthognathic surgery, based on literature on the postoperative condylar position in orthognathic surgery. From the studies reviewed, it was suggested that the preoperative position of the condyle was not the desired postoperative position in orthognathic surgery.

Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry.

The purpose of this study was to examine the changes in the temporomandibular joint (TMJ) and ramus after sagittal split ramus osteotomy (SSRO) with and without Le Fort I osteotomy. The subjects consisted of 87 Japanese patients diagnosed with mandibular prognathism with and without asymmetry. They were divided into 2 groups (42 symmetric patients and 45 asymmetric patients). The TMJ disc tissue was assessed by magnetic resonance imaging (MRI) and the TMJ space, condylar and ramus angle were assessed by computed tomography (CT) preoperatively and postoperatively. Medial joint space on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0043), and coronal ramus angle on the non-deviation side in the asymmetry group was significantly larger than that in the symmetry group preoperatively (P = 0.0240). The horizontal condylar angle on the deviation side in the asymmetry group was significantly larger than that in the symmetry group (P = 0.0302), posterior joint space on the non-deviation side in the symmetry group was significantly larger than that in the asymmetry group postoperatively (P = 0.00391). The postoperative anterior joint space was significantly larger than the preoperative value on both sides in both groups (the deviation side in the symmetry group: P = 0.0016, the non-deviation side in the symmetry group: P < 0.0001, the deviation side in the asymmetry group: P = 0.0040, the non-deviation side in the asymmetry group: P = 0.0024). The preoperative disc position could was not changed in either group. These results suggest that significant expansion of anterior joint space could occur on the deviation side and non-deviation side in the asymmetry group as well as on both sides in the symmetry group, although disc position did not change in either group.

Effect of self-setting α-tricalcium phosphate between segments for bone healing and hypoaesthesia in lower lip after sagittal split ramus osteotomy.

AIMS: The aim of this study was to evaluate hypoaesthesia of the lower lip and bone formation using self-setting α-tricalcium phosphate (Biopex(®)) between the proximal and distal segments following sagittal split ramus osteotomy (SSRO) with bent absorbable plate fixation. SUBJECTS AND METHODS: The subjects were 40 patients (80 sides) who underwent bilateral SSRO setback surgery. They were divided into a Biopex(®) group (40 sides) and a control group (40 sides). The Biopex(®) was inserted into the anterior part of the gap between the segments in the Biopex(®) group. Trigeminal nerve hypoaesthesia in the region of the lower lip was assessed bilaterally using the trigeminal somatosensory-evoked potential (TSEP) method. Ramus square, ramus length, and ramus width, the square of the Biopex(®) at the horizontal plane under the mandibular foramen were assessed preoperatively, immediately after surgery, and 1year postoperatively by computed tomography (CT). RESULTS: The mean measurable period and standard deviation were 9.3±15.7weeks in the control group, 5.3±8.3weeks in the Biopex(®) group, and there was no significant difference. Ramus square after 1year was significantly larger than that prior to surgery and new bone formation was found between the segments in both groups (P<0.05). In the Biopex(®) group, the square of the Biopex(®) after 1year was significantly smaller than that immediately after surgery (P<0.05). CONCLUSION: This study suggested that inserting Biopex(®) in the gap between the proximal and distal segments was useful for new bone formation and it did not prevent the recovery of lower lip hypoaesthesia after SSRO with bent absorbable plate fixation.

Bone healing of critical-sized nasal defects in rabbits by statins in two different carriers.

OBJECTIVES: To evaluate bone healing following implantation of a statin with two different carriers in rabbit nasal bone using histological and immunohistochemical methods. MATERIALS AND METHODS: Twenty adult, male Japanese white rabbits (age: 12-16 weeks, weight: 2.5-3 kg) were used in this study. Five bone circular defects (5 mm in diameter) per rabbit were created in the nasal bone while preserving the nasal membrane. In the experimental groups, 2.5 mg/ml simvastatin dissolved in 0.2 ml water with hydrogel was implanted in one group, 2.5 mg/ml simvastatin dissolved in 0.2 ml water with an atelocollagen sponge (ACS) in the second group with, only the hydrogel in the third group and only an ACS in the fourth group. No material was implanted in the control group. Four animals were killed in each period, at 1, 2, 4, 8 and 12 weeks postoperatively. The parts that had been operated on were removed and prepared for histological assessment. The expression of bone morphogenetic proteins (BMP)-2 and the bone ration was evaluated using histological and immunohistochemical methods. RESULTS: No significant differences were observed between the simvastatin with hydrogel group and the simvastatin with ACS group at 1, 2, 4, 8 and 12 weeks postoperatively regarding expression of BMP-2, although the number of cells that stained positive for BMP-2 in both of the implanted groups increased significantly at 2 and 4 weeks postoperatively in comparison with the control group (P<0.0001). For new bone area ratio, there were no significant differences between the simvastatin with hydrogel groups and the simvastatin with ACS group after 2, 4, 8 and 12 weeks, although these groups showed higher value than control group (P<0.0001). CONCLUSION: This study suggests that both the simvastatin with hydrogel and simvastatin with ACS implants showed similar BMP-2 expression and new bone formation, and there were no significant differences between the two carriers.

Skeletal stability after mandibular setback surgery: comparisons among unsintered hydroxyapatite/poly-L-lactic acid plate, poly-L-lactic acid plate, and titanium plate.

PURPOSE: The purpose of this study is to compare the time-course changes in condylar long-axis and skeletal stability after sagittal split ramus osteotomy (SSRO) with an unsintered hydroxyapatite (u-HA)/poly-L-lactic acid (PLLA) plate, PLLA plate, or titanium plate. PATIENTS AND METHODS: Of 60 Japanese patients diagnosed with mandibular prognathism, 20 underwent SSRO with a u-HA/PLLA plate system, 20 underwent SSRO with a PLLA plate system, and 20 underwent SSRO with a conventional titanium plate system. The time-course changes in condylar long-axis and skeletal stability were assessed by use of axial, frontal, and lateral cephalograms. RESULTS: Compared with the u-HA/PLLA group, the titanium group showed a significantly greater change in the right condyle angle between initially and 1 month (P = .0105) and intercondylar axes angle between 1 and 3 months (P = .0013). The PLLA group showed a significantly greater change than the titanium group (P = .0043) and u-HA/PLLA group (P = .0002) in terms of ramus inclination between 1 and 3 months; however, there were no significant differences among the 3 groups in the other measurements for each time interval. CONCLUSION: This study suggests that there are no significant differences in postoperative time-course changes among a u-HA/PLLA plate system, PLLA plate system, and conventional titanium plate system.

Assessment of bone healing after Le Fort I osteotomy with 3-dimensional computed tomography.

PURPOSE: The purpose of this study was to examine bone healing after Le Fort I osteotomy in Class III patients. PATIENTS AND METHODS: The study group consisted of 18 Japanese patients with mandibular prognathism with and without asymmetry, maxillary retrognathism or open bite. A total of 36 sides were examined. Le Fort I osteotomy was performed without a pterygoid osteotome, with an ultrasonic curette used to remove interference at the pterygomaxillary region. Titanium plates (Universal Mid-face fixation module, Stryker, Freiburg, German) were used for four patients, absorbable plates (poly-L-lactic acid (PLLA): NEOFIX(®), Gunze, kyoto, Japan) were used for four patients and other absorbable plates (uncalcined and unsintered hydroxyapatite and poly-L-lactic acid (uHA/PLLA): super FIXSORB(®)MX, Takiron Co. Ltd, Osaka, Japan) were used for 10 patients, in the same manner. Postoperative computed tomography (CT) was analyzed for all patients pre-operatively and 1 year postoperative. The anterior and lateral areas between the maxillary segments were measured with 3-dimensional (3D) CT. Bone healing at the pterygomaxillary region was also assessed. RESULTS: There were no significant differences in the area of bone defect healing among the plate types. The areas of bone defect after 1 year were significantly smaller than that immediately after surgery on the right side (p=0.0145) and left side (p=0.0010) in the frontal view and right side in the lateral view (p=0.0118). Bone healing at the pterygomaxillary junction was found in all cases without artificial pterygoid plate fracture. Fourteen of 22 sides with artificial pterygoid plate fracture by an ultrasonic curette showed bone continuity between the pterygoid plate and posterior part of maxilla. CONCLUSION: This study suggested that bony healing could occur in spaces between the segments of maxilla and pterygomaxillary regions as well as the region of the anterior and lateral walls in the maxilla, but it is not always complete within 1 year after Le Fort I osteotomy.