Venous malformations of the head and neck: current concepts in management.

Low-flow venous malformations are congenital lesions and they are the third most common vascular anomaly in the head and neck. In this paper, the third in a series of three educational reviews, we discuss current trends in their management, and include a summary of common sclerosant agents used in their control.

Is an osteotome necessary for pterygomaxillary dysjunction or dysjunction through the tuberosity during Le Fort I osteotomy? A systematic review.

Pterygomaxillary dysjunction with an osteotome is commonly used to mobilise the maxilla during Le Fort I osteotomy, despite the risk of serious complications. Different instruments and positions have been tried, including dysjunction through the tuberosity. Down fracture by digital pressure alone has also been advocated, but to our knowledge has not been widely adopted. We have therefore reviewed published papers to see if there is any clinical or anatomical evidence for the use of osteotomes to mobilise the maxilla vertically during a Le Fort I osteotomy for either pterygomaxillary dysjunction or dysjunction through the tuberosity. We found only one paper that analysed the anatomy of the pterygomaxillary fissure and described small bony bridges and syncondroses across the joint. We found no clinical or anatomical evidence for the use of osteotomes in pterygomaxillary separation or separation through the tuberosity. A large clinical trial on down fracture of the maxilla by digital pressure alone showed no serious complications, and we found no strong evidence to justify the use of osteotomes in pterygomaxillary dysjunction or dysjunction through the tuberosity. We have successfully used digital pressure alone in 138 consecutive Le Fort I osteotomies, and we encourage our colleagues to consider adopting this approach.