%0 Journal Article
%A Aragón Niño, Íñigo
%A Castillo Pardo de Vera, José Luis del
%A Cebrián Carretero, José Luis
%A López Martinez, Clara
%A Tapia Salinas, Blanca
%A Zheng, Chongyang
%A Navarro Cuéllar, Carlos
%T Directed pterygomaxillary disjunction versus direct downfracture in Le Fort I osteotomy: application of a fracture quality framework using bilateral ten-point cone-beam computed tomography in a retrospective cohort of 205 patients
%D 2026
%U https://hdl.handle.net/20.500.14352/134171
%X Background: Control of the pterygomaxillary junction (PMJ) fracture is critical in Le Fort I osteotomy. We testedwhether a directed PMJ disjunction (osteotome-assisted intermediate release) improves fracture quality, symmetry, and alignment versus direct downfracture.Material and Methods: Single-center retrospective comparative cohort (January 2019-April 2025). Two hundredfive consecutive patients underwent Le Fort I: directed disjunction (n=127) or direct downfracture (n=78). Postoperative cone-beam computed tomography at day 90-110 was scored with a bilateral ten-point map. Primary outcomes were per-side quality (poor/good/excellent) and a patient-level overall quality status (poor/fair/good/verygood/excellent). Inclusive and strict “clean-cut,” symmetry, and alignment were predefined. Group comparisonsused chi-square or Fisher’s exact tests (two-sided α=0.05).Results: Directed disjunction shifted side-level quality toward inferior, contained patterns: “excellent” 59.1% vs6.4% (right) and 48.0% vs 12.8% (left); “poor” 22.0% vs 91.0% and 29.9% vs 85.9% (all p<0.001). Patient-level status improved (poor 38.6% vs 98.7%; excellent 37.8% vs 1.3%; p<0.001). Perfect symmetry rose to 49.6%vs 1.3% and correct alignment to 61.4% vs 1.3% (p<0.001). Maxillary tuberosity involvement decreased from60.3%/56.4% (right/left) without disjunction to 2.4%/5.5% with disjunction. Inclusive and strict clean-cut werehigher with directed disjunction (69.3% vs 37.2% and 53.5% vs 9.6%; p<0.001).Conclusions: Within a standardized early postoperative window, directed PMJ disjunction was associated with superior fracture quality, greater bilateral coordination, and fewer undesired trajectories than downfracture. Adoption ofa targeted release and standardized reporting is supported. Interpretation is limited by the retrospective single-centerdesign and focus on fracture behavior without complication or long-term outcome analysis.
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