Directed pterygomaxillary disjunction versus direct downfracture in Le Fort I osteotomy: application of a fracture quality framework using bilateral ten-point cone-beam computed tomography in a retrospective cohort of 205 patients

Within a standardized early postoperative window, directed PMJ disjunction was associated with superior fracture quality, greater bilateral coordination, and fewer undesired trajectories than downfracture. Adoption of a targeted release and standardized reporting is supported. Interpretation is limited by the retrospective single-center design and focus on fracture behavior without complication or long-term outcome analysis.