Comparative study to assess efficacy of leverage technique v/s shams technique in lefort i osteotomy down fracturing

Lefort 1 osteotomies are very commonly performed orthognathic surgical procedure and is of wide application in correcting dentofacial deformities. The down fracturing technique of maxilla is an important step in Lefort osteotomy and is associated with occasional trouble shooting. Aim of the study: was to evaluate the ease of two down fracturing techniques –by using a 0.5 mm stainless steel wire traction and using modified leverage technique using two periosteal elevator and chisel. Patients and methods: 42 patients who reported to the department of oral & maxillofacial surgery for correction of maxillary deformities requiring lefort 1 osteotomy were selected for the study. 21 patients underwent down fracturing using stainless steel wire and 21 patients underwent down fracturing using modified leverage technique. The techniques were compared for the time taken for down fracture, lateral movement obtained after down fracturing and associated complications. Results: The comparison between two groups showed no significant difference in the time taken for down fracturing the maxilla. The lateral movement of maxilla after down fracturing was more in technique with stainless steel and was statistically significant. The leverage technique had two cases with wrong split of maxilla, where as mucosal tear and breakage of anterior nasal spine was noted in stainless steel technique. Conclusion: Both the techniques provided efficient down fracturing however technique of using stainless steel provided additional benefit of greater amount of lateral movement and helped in holding into position during rigid fixation.