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    Evaluation of stress by finite element analysis of the midface and skull base at the time of midpalatal osteotomy in models with or without pterygomaxillary dysjunction
    (Churchill Livingstone, 2018) Esen, Alparslan; Ertan, Soğancı; Dolanmaz, Elvan; Dolanmaz, Doğan
    Surgically-assisted rapid maxillary expansion (SARME) is commonly used to treat skeletally mature patients with transverse discrepancies. Some osteotomies are made in areas that resist expansion, but there is no clear consensus about the sequence in which the osteotomies are made. Some clinicians do the pterygomaxillary osteotomy last, while others do it before the midpalatal osteotomy. We used the finite element method to measure the stresses on the midface, cranial base and pterygoid plates at the time of midpalatal osteotomy in two models, one with and one without pterygomaxillary dysjunction (PMD). In both, SARME consisted of maxillary bilateral osteotomy from the piriform rim to the pterygoid plate. Midpalatal osteotomy was also done in both. In the PMD model, minimum principal stresses increased on the midface, and maximum principal and von Mises stresses increased at the cranial base and on the pterygoid plates. Our results suggest that the stresses on the midface and cranial base can be reduced during midpalatal osteotomy in adults if the pterygomaxillary osteotomy is done last.
  • Küçük Resim
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    Evaluation of stress distribution in critical anatomic regions following the Le Fort I osteotomy by three-dimensional finite element analysis
    (Churchill Livingstone, 2019) Esen, Alparslan; Dolanmaz, Elvan; Dolanmaz, Doğan
    In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.