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In Le Fort type I osteotomy, separation of the pterygomaxillary suture is . dangerous process which must be carried out during the surgical procedure. Fittness of osteotomes best suited for safe separation of the pterygomaxillary suture was studied by measuring the strain distribution over surrounding bone structure and examining the direction of the fracture line. The following results were obtained : 1) Measurement of the static strain revealed that the strain exerted on the medial and lateral plates of the pterygoid process can be reduced when the suture is initially separated with an Obwegeser's osteotome and finally with a swan's neck osteotome. 2) Application of a straight osteotome at different angles indicated that a straight osteotome wedged into the posterior aspect of the pterygomaxillary suture at 30 degrees to the sagittal plane from reduces the static strain exerted on the medial and lateral plates of the pterygoid process. 3) Measurement of the dynamic strain during the rupture of the pterygomaxillary suture revealed that separation of the suture initially as well as finally with a swan's neck osteotome reduces the strain exerted on the medial and lateral plates of the pterygoid process. This finding suggests that this osteotome enables safe separation of the suture. 4) Fracture of the pterygoid process during the separation of the pterygomaxillary suture showed two fracture patterns, a horizontal fracture of the upper part and also a horizontal fracture of the lower one. 5) In every experiment, after separation of the unilateral pterygomaxillary suture, strain increased at almost every measuring point, therefore final separation of pterygomaxillary suture is a more dangerous phase of the procedure than initial separation. 6) In separation of the suture with an Obwegeser's osteotome, as routinely used in orthognathic surgery, safe separation cannot be accomplished unless the blade is correctly applied to the suture and infraposterior compression of the pterygoid process is avoided.

Study of the dynamics of separation of the pterygomaxillary suture in Le Fort type I osteotomy as an approach to its safe accomplishment.