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Linear and angular measurement using cone-beam computed tomography to enhance safety in Le Fort I osteotomy with tuberosity cut



The study aimed to evaluate surgical angles for tuberosity cut and linear and angular measurements for all horizontal cuts in Le Fort I osteotomy using cone-beam computed tomography (CBCT).

Materials and methods

This study included 189 CBCT scans to assess the surgical angles on 3 different sites distal to maxillary second molars relative to the midsagittal plane (MSP) and the buccal cortical plane (BCP) in relation to the descending palatine foramen for tuberosity cut. The linear and angular measurements for all horizontal cuts in Le Fort I osteotomy were also evaluated.


The mean surgical angles for tuberosity cut varied from 58.90 to 95.28° and 74.85 to 100.93° according to the MSP and the BCP, respectively. For the horizontal cuts, mean lengths (angles) for posterior buccal and lateral nasal wall osteotomies were 27.44 mm (13.62°) and 33.20 mm (9.60°), respectively, and a mean length of 47.12 mm was measured for nasal septum osteotomy. Additionally, the presence of impacted third molar resulted in significantly higher mean surgical angles than those with fully erupted or without third molars (p < 0.01).


Overall, angles running through the buccal midpoint of the third molars relative to the MSP (76.56°) or the BCP (92.31°) might be the most appropriate in clinical practice. Furthermore, some caution seems warranted when performing tuberosity cuts with the impacted third molars.

Clinical relevance

To avoid potential damage to the descending palatine artery for tuberosity cut in Le Fort I osteotomy.

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The authors wish to thank Ms. Kar Yan Li, Centralised Research Lab, The University of Hong Kong, for the assistance regarding the statistical analysis.

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Authors and Affiliations



Conceptualization: Yiu Yan Leung; methodology: Liuling Hui and Yiu Yan Leung; formal analysis and investigation: Liuling Hui and Kuo Feng Hung; writing—original draft: Liuling Hui; writing—review and editing: Yiu Yan Leung and Michael Marc Bornstein; supervision: Yiu Yan Leung.

Corresponding author

Correspondence to Yiu Yan Leung.

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Ethics approval

This study was conducted in full accordance with the Declaration of Helsinki 2013 ( The study protocol was submitted to and approved by the local Institutional Review Board (approval number: UW 20–803).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Hui, L., Hung, K.F., Bornstein, M.M. et al. Linear and angular measurement using cone-beam computed tomography to enhance safety in Le Fort I osteotomy with tuberosity cut. Clin Oral Invest (2022).

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  • Orthognathic surgery
  • Osteotomy
  • Le Fort
  • Maxilla
  • Cone-beam computed tomography