Pterygomaxillary Disjunction and its Influence on the Result of Surgically Assisted Maxillary Expansion: A Systematic Review and Meta-analysis

Aim The aim of this study was to evaluate the available evidence to identify the influence of pterygomaxillary disjunction on the result of surgically assisted maxillary expansion. Background LeFort I type osteotomy with disjunction of the pterygomaxillary suture is a procedure widely used in maxillofacial surgery. However, the need for its performance during surgically assisted maxillary expansions has been discussed in literature, since serious complications can be caused during this stage. Review results Systematic review of articles was performed using three databases (PubMed, Web of Science, and Cochrane) published until May 2019. After applying the selection criteria, five articles were included in the systematic review, with a total of 141 patients. Meta-analysis showed the absence of significant difference between intervention and control groups in the preoperative period (standardized mean difference = -0.28; confidence interval, CI 95% = -0.81, 0.26; p = 0.31) and postoperative period (standardized mean difference = -0.12; 95% CI = -0.65, 0.42; p = 0.66). In general, the heterogeneity of statistical estimates was low (I2 = 0%). Conclusion No statistically significant difference was observed between control group (without pterygomaxillary disjunction) and intervention group (with pterygomaxillary disjunction). Clinical significance Based on the data analyzed in this systematic review, it could be concluded that pterygomaxillary disjunction is not a mandatory step to achieve satisfactory maxillary expansion. Thus, not performing pterygomaxillary disjunction can prevent complications and reduce surgical time.