Postoperative Alterations in Maxillary Sinus Health Following Le Fort I Osteotomy: A CBCT-Based Retrospective Study

Year 2025, Volume: 49 Issue: 3, 165 - 171, 12.12.2025

Salih Eren Meral , Hakan Tuz

https://doi.org/10.65022/clindentres.1804598

Abstract

Background and Aim: The Le Fort I osteotomy is often used to address maxillomandibular discrepancies and might affect maxillary sinus health because of its proximity to the maxillary sinuses. This study aimed to evaluate postoperative alterations in maxillary sinus membrane thickness, osteomeatal patency, and the development of secondary nasoantral ostium using cone-beam computed tomography (CBCT).
Materials and Methods: This retrospective study involved 28 patients (17 females, 11 males) who underwent Le Fort I osteotomy at Hacettepe University from 2013 to 2023. Preoperative and postoperative CBCT scans taken between 6 and 24 months after surgery were analyzed to measure the Schneiderian membrane (SM) thickness, determine thickening grades and patterns, and assess osteomeatal patency and secondary ostium formation. Statistical analyses were performed using the Wilcoxon signed-rank, Mann–Whitney U, and McNemar tests, with a significance level of p<0.05.
Results: Median SM thickness significantly increased postoperatively from 0.75 mm (IQR:0.50–4.37) to 2.60 mm (IQR:0.62–6.97) (p=0.016). Sinuses associated with fixation materials and bone substitutes showed markedly greater thickening (median 8.16 mm, p<0.001). The distribution of thickening grades and patterns shifted slightly toward higher severity, though not significantly. Postoperative obstruction of the osteomeatal complex was observed in 4 sinuses (7.14%), and a secondary nasoantral ostium developed in 5 sinuses (8.92%).
Conclusion: Le Fort I osteotomy may lead to persistent postoperative thickening of the maxillary sinus membrane, particularly near surgical materials. Although minor changes in sinus health were observed, the formation of secondary ostia and osteomeatal obstruction highlight the importance of longterm radiological monitoring following orthognathic surgery.

Keywords

Le Fort I osteotomy , maxillary sinus , Schneiderian membrane , sinus membrane thickening , osteomeatal complex

Ethical Statement

The study was approved by the Hacettepe University Health Sciences Research Ethics Board. (SBA-25/539)

Supporting Institution

none declared

Thanks

none declared

References

• Iwamoto M, Watanabe M, Yamamoto M, Narita M, Kamio T, Takaki T et al. Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis. Maxillofac Plast Reconstr Surg 2019; 41: 1-5.
• Taşkıran G, Meral S, El H, Tüz H. Three-dimensional evaluation of upper airway changes following maxillomandibular surgery for Class III deformity with or without advancement genioplasty. Int J Oral Maxillofac Surg 2025.
• Akbulut N, Çakmak EŞK, Bayrak S. Assessment of maxillary sinus changes after Le Fort I osteotomy surgery. J. Craniofac. Surg 2020; 31: 497-501.
• Chow LK, Singh B, Chiu WK, Samman N. Prevalence of postoperative complications after orthognathic surgery: a 15-year review. J Oral Maxillofac Surg 2007; 65: 984-992.
• Jang T-S, Lee S-W, Lee B-S, Shim G-J, Seon S, Ohe J. Sinus mucosal healing pattern according to pterygomaxillary disjunction type after Le Fort I osteotomy. J Korean Assoc Oral Maxillofac Surg 2022; 48: 292-296.
• Kaleem A, Balamurugan R. Maxillary sinus recovery after LeFort I osteotomy: a prospective clinical and radiographic evaluation. J Oral Med Oral Surg 2019; 25:39.
• Kramer F-J, Baethge C, Swennen G, Teltzrow T, Schulze A, Berten J et al. Intra-and perioperative complications of the LeFort I osteotomy: a prospective evaluation of 1000 patients. J. Craniofac. Surg 2004; 15: 971-977.
• Scarfe WC, Angelopoulos C. CBCT use in daily practice. Maxillofacial Cone Beam Computed Tomography: Principles, Techniques and Clinical Applications 2018: 115-89.
• Ueki K, Yoshizawa K, Moroi A, Hotta A, Tsutsui T, Fukaya K et al. Evaluation of maxillary sinus after Le Fort I osteotomy using various fixation materials. J Craniomaxillofac Surg 2017; 45: 552-557.
• Kuligowski P, Jaroń A, Preuss O, Gabrysz-Trybek E, Bladowska J, Trybek G. Association between Odontogenic and Maxillary Sinus Conditions: A Retrospective Cone-Beam Computed Tomographic Study. J Clin Med 2021; 10.
• Huang Y-T, Hu S-W, Huang J-Y, Chang Y-C. Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography. J Dent Sci 2020; 16: 275-279. Psillas G, Papaioannou D, Petsali S, Dimas G, Constantinidis J. Odontogenic maxillary sinusitis: A comprehensive review. J Dent Sci 2020; 16: 474-481.
• Pons R, Giralt M, Nart J, De Tapia B, Hernández-Alfaro F, Monje A. Peri-implantitis and maxillary sinus membrane thickening: A retrospective cohort study. Clin Oral Implants Res 2024; 35:757- 770.
• Jo S, Kim Y-K, Choi Y-H. Histological Evaluation of the Healing Process of Various Bone Graft Materials after Engraftment into the Human Body. Materials 2018; 11.
• İncebeyaz B, Öztaş B. Evaluation of osteomeatal complex by cone-beam computed tomography in patients with maxillary sinus pathology and nasal septum deviation. BMC Oral Health 2024; 24.
• Taxis J, Florian H-R, Napodano G, Rink M, Nieberle F, Himmelstoß K et al. Patient Age Predicts Nasal Septal Deviation in Orthognathic Surgery: A Non-Randomized Clinical Trial of 102 Participants. Medicina 2024; 60.
• Koç O, Tüz H. Effect of maxillary surgical movement on nasal cavity and maxillary sinus dimensions and function after Le Fort I osteotomy. Int. J. Oral Maxillofac Surg 2022; 51: 806-812.
• Shin Y-M, Lee S-T, Kwon T. Surgical correction of septal deviation after Le Fort I osteotomy. Maxillofac Plast Reconstr Surg 2016; 38.
• Shetty S, Bayatti SWA, Al-Rawi N, Samsudin R, Marei H, Shetty R et al. A study on the association between accessory maxillary ostium and maxillary sinus mucosal thickening using cone beam computed tomography. Head Face Med 2020; 17.
• Matheny KE, Duncavage JA. Contemporary indications for the Caldwell-Luc procedure. Curr Opin Otolaryngol Head Neck Surg 2003; 11: 23-26.
• Valstar M, Baas E, Rijdt JT, De Bondt B, Laurens E, De Lange J. Maxillary sinus recovery and nasal ventilation after Le Fort I osteotomy: a prospective clinical, endoscopic, functional and radiographic evaluation. Int. J. Oral Maxillofac Surg 2013; 42: 1431- 1436.
• Nocini P, D’Agostino A, Trevisiol L, Favero V, Pessina M, Procacci P. Is Le Fort I Osteotomy Associated With Maxillary Sinusitis? J Oral Maxillofac Surg 2016; 74: 400.e1-400.e12.