Massive epistaxis due to pseudoaneurysm of the sphenopalatine artery: a rare post-operative complication of orthognathic surgery

AbstractObjective:To introduce pseudoaneurysm of the sphenopalatine artery as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.Methods:Case report and literature review.Results:This paper reports a case of acute life-threatening epistaxis following Le Fort I osteotomy. Computed tomography and angiography showed a pseudoaneurysm of the sphenopalatine artery, which was successfully treated by endovascular embolisation.Conclusion:Although a pseudoaneurysm of the sphenopalatine artery following Le Fort I osteotomy is extremely rare, it should be considered as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.

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Life-threatening, delayed epistaxis after Le Fort I osteotomy: a case report

10.21203/rs.3.rs-485729/v1 ◽

2021 ◽

Author(s):

Amir Eleuch ◽

Maha Ben Rejeb ◽

Anis Ayadi ◽

Samia Ayachi ◽

Ramzi Moatemri ◽

...

Keyword(s):

Case Report ◽

Maxillary Artery ◽

Internal Maxillary Artery ◽

Le Fort I Osteotomy ◽

Case Presentation ◽

Le Fort ◽

Operative Complication ◽

Life Threatening ◽

The Right ◽

Le Fort I

Abstract Introduction: When performing a Le Fort 1 osteotomy, there is always a risk of injuring the internal maxillary artery or one of its branches. This diagnosis should be considered when confronted to recurrent or massive epistaxis following surgery.Case presentation: The authors present a case of a life-threatening, delayed and massive epistaxis caused by a ruptured pseudoaneuvrysm of the right sphenopalatine artery as a post-operative complication of a Le Fort I osteotomy successfully managed by anterior and posterior nasal packing.Conclusion: Despite its simplicity and attested reliability, Le Fort I osteotomy is not completely free of complications.

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Le Fort I osteotomy facilitated nasotracheal intubation in a patient with concha bullosa and septal deviation: a case report

10.22514/sv.2021.062 ◽

2021 ◽

Keyword(s):

Case Report ◽

Nasal Cavity ◽

Orthognathic Surgery ◽

Nasotracheal Intubation ◽

Maxillofacial Surgery ◽

Septal Deviation ◽

Concha Bullosa ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Le Fort I

Introduction: Nasotracheal intubation (NTI) is preferred for general anesthesia in maxillofacial surgery. However, NTI is often traumatic or even unsuccessful, particularly in patients with a narrow nasal pathway. In this case report, we describe a less traumatic NTI approach using maxillary downfracture of Le Fort I osteotomy. Case presentation: A 19-year-old woman was admitted with a skeletal Class III malocclusion and scheduled to undergo bimaxillary orthognathic surgery. A preoperative evaluation revealed no other medical history and abnormal laboratory findings. Preoperative computed tomography showed nasal septal deviation, concha bullosa, and turbinate hypertrophy. A nasal Ring-Adair-Elwyn endotracheal tube and a tube exchanger could not be inserted via NTI because of her narrow nasal cavity. An oral intubation was performed temporarily and surgery was started. After a maxillary downfracture was performed, which made the nasal cavity wider than before, NTI was successfully conducted without difficulty. The patient was ventilated without any problems, and the operation was continued. Postoperatively, the patient had no further complications and her vital parameters were all stable. Conclusions: This case report suggests that NTI after maxillary downfracture of Le Fort I osteotomy can be a good alternative that can be successfully performed with less trauma in patients undergoing orthognathic surgery who are preoperatively evaluated as having a narrow nasal cavity.

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Surgical correction of vertical maxillary excess associated with mandibular self-rotation

RSBO ◽

10.21726/rsbo.v14i1.639 ◽

2017 ◽

Vol 14 (1) ◽

pp. 56-61

Author(s):

Michelle Nascimento Meger ◽

Fernanda Tiboni ◽

Felipe Silvério dos Santos ◽

Thalyta Verbicaro ◽

Tatiana Miranda Deliberador ◽

...

Keyword(s):

Case Report ◽

Orthognathic Surgery ◽

Rare Condition ◽

Final Position ◽

Le Fort I Osteotomy ◽

Skeletal Deformity ◽

Le Fort ◽

Le Fort I ◽

Gummy Smile

The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJ remained asymptomatic after 9 months of postoperative follow-up.

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Surgical correction of vertical maxillary excess associated with mandibular self-rotation

RSBO ◽

10.21726/rsbo.v1i1.387 ◽

2017 ◽

Vol 1 (1) ◽

pp. 56 ◽

Cited By ~ 1

Author(s):

Michelle Nascimento Meger ◽

Fernanda Tiboni ◽

Felipe Silvério Dos Santos ◽

Thalyta Verbicaro ◽

Tatiana Miranda Deliberador ◽

...

Keyword(s):

Case Report ◽

Orthognathic Surgery ◽

Rare Condition ◽

Final Position ◽

Le Fort I Osteotomy ◽

Skeletal Deformity ◽

Le Fort ◽

Le Fort I ◽

Gummy Smile

Introduction: The Class I skeletal deformity associated with vertical maxillary excess is a rare condition reported in the literature. Surgical impaction allows the correction of the long face and gummy smile. Objective: This case report aimed to evaluate the positioning of the condyle after Le Fort I osteotomy associated with mandibular selfrotation. Case report: The patient underwent orthognathic surgery for the correction of maxillary vertical excess. Tomography studies were performed to evaluate the initial and final position of the condyle. The patient improved mastication, breathing and phonetics, with esthetic benefit. Conclusion: After the Le Fort I osteotomy and mandibular self-rotation, the condyle remained stable occupying a new anterior-superior position in the glenoid fossa and patient’s TMJremained asymptomatic after 9 months of postoperative follow-up.

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An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report

Journal of the Korean Association of Oral and Maxillofacial Surgeons ◽

10.5125/jkaoms.2019.45.6.364 ◽

2019 ◽

Vol 45 (6) ◽

pp. 364

Author(s):

Byungho Park ◽

Wan-Hee Jang ◽

Bu-Kyu Lee

Keyword(s):

Case Report ◽

Orthognathic Surgery ◽

Le Fort I Osteotomy ◽

Le Fort ◽

Le Fort I

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Maxillary Aseptic Necrosis After Le Fort I Osteotomy: A Case Report and Literature Review

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2009.07.099 ◽

2010 ◽

Vol 68 (6) ◽

pp. 1402-1407 ◽

Cited By ~ 20

Author(s):

Felipe Ladeira Pereira ◽

Renato Yassutaka Faria Yaedú ◽

Adriana Passanezi Sant'Ana ◽

Eduardo Sant'Ana

Keyword(s):

Case Report ◽

Literature Review ◽

Le Fort I Osteotomy ◽

Aseptic Necrosis ◽

Le Fort ◽

Le Fort I

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W-Shaped Osteotomy to Avoid Paranasal Deformity After Standard Le Fort I in Orthognathic Surgery

Plastic Surgery ◽

10.1177/2292550320969655 ◽

2020 ◽

pp. 229255032096965

Author(s):

Mario Santagata ◽

Nicola Sgaramella ◽

Fabrizio Chirico ◽

Salvatore D’Amato ◽

Ivo Ferrieri ◽

...

Keyword(s):

Orthognathic Surgery ◽

Preliminary Report ◽

Le Fort I Osteotomy ◽

Maxillary Bone ◽

Le Fort ◽

First Time ◽

Le Fort I ◽

Pyriform Aperture

When occlusal alterations are not accompanied by paranasal deficiencies, mobilization of the maxilla via Le Fort I osteotomy should be made with a different design. In this preliminary report, a W-shaped osteotomy that doesn’t change the position of the maxillary bone surrounding the pyriform aperture was presented for the first time. Advantages and indications of this new procedure are discussed.

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