scholarly journals An atypical case of trigeminal trophic syndrome: A legal medicine perspective in medical responsibility

2017 ◽  
Vol 5 ◽  
pp. 2050313X1772354
Author(s):  
Alessandro di Luca ◽  
Massimo Ralli ◽  
Sara Hemied ◽  
Marco de Vincentiis ◽  
Natale Mario di Luca
Keyword(s):  
Trigeminal Nerve ◽  
Rare Complication ◽  
Maxillofacial Surgery ◽  
Previous History ◽  
Class Iii ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Medical Responsibility ◽  
Trigeminal Trophic Syndrome ◽  
Le Fort I

Background: Trigeminal trophic syndrome is a rare complication of peripheral or central damage to the trigeminal nerve characterized by anesthesia, paresthesia and a secondary persistent facial ulceration. Methods: We describe the case of a 40-year-old woman with previous history of Le Fort I osteotomy for a class III malocclusion who developed trigeminal trophic syndrome. Atypically, the cutaneous symptoms appeared bilaterally and 8 years after surgery. Results: Differential diagnosis was based on clinical history, tissue biopsy and serologic evaluation. Atypical findings could be linked to the surgical burdens of Le Fort I osteotomy, a procedure characterized by a bilateral incision on the maxillofacial bones with a reasonable probability of causing a bilateral injury of the peripheral branches of the trigeminal nerve. Conclusion: Although the long delay between trigeminal trophic syndrome onset and surgery and the absence of adequate medical evidence cannot confirm a link with previous surgery in this case, the increasing number of maxillofacial surgery cases suggests that this complication may be more frequent in the next decades, and thus, involved specialists should be aware of this condition as a possible complication of maxillofacial surgery procedures.

scholarly journals TRIGEMINO CARDIAC REFLEX IN ORAL & MAXILLOFACIAL SURGERY – A REVIEW

2021 ◽  
pp. 1-2
Author(s):  
Venu Sameera Panthagada ◽  
Ravi Raja Kumar Saripalli ◽  
Manoj Kumar Kanta
Keyword(s):  
Trigeminal Nerve ◽  
Preventive Measures ◽  
Pressure Effect ◽  
Maxillofacial Surgery ◽  
Strabismus Surgery ◽  
Effective Management ◽  
Le Fort ◽  
Le Fort I ◽  
Maxillary Tuberosity

Trigemino cardiac reflex (TCR) which was originally called as OCCULOCARDIAC REFLEX is a physiological response due to the pressure effect on the largest cranial nerve, the trigeminal nerve. Oral and maxillofacial procedures can induce the development of this reflex. TCR is a triad of bradycardia , bradypnea and gastric motility changes due to the efferent activation of the vagal nerve in response to the pressure distribution in Trigeminal nerve. TCR may be generated as a result of procedures or conditions that increase intraocular pressure, strabismus surgery, nasal packing after rhinoplasty, the reduction of zygoma and zygomatic arch fractures, elevation of bone flap or osteotomies, reflection of a palatal flap for removal of a mesiodens, during Le Fort I downfractures, sagittal split ramus retraction, midface disimpaction, cutting maxillary tuberosity, and temporomandibular joint arthroscopy. The purpose of this paper is to discuss the pathophysiology and to review the main risk factors , treatment, prevention and management with emphasis on the role of maxillofacial surgeons and attending anesthetist. Maxillofacial surgeons should be familiar with presentations, preventive measures for the effective management of this complication.

Evaluation of Lefort I Osteotomy Line and Pterygomaxillary Junction Region in Patients With Cleft Lip and Palate

2020 ◽  
pp. 105566562096957
Author(s):  
Bahadır Sancar ◽  
Şuayip Burak Duman
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Le Fort I Osteotomy ◽  
Maxillary Hypoplasia ◽  
Le Fort ◽  
Osteotomy Line ◽  
Le Fort I ◽  
Pterygomaxillary Junction

Objective: This study aimed to evaluate the Le Fort I osteotomy line and pterygomaxillary junction via cone-beam computed tomography in individuals with cleft lip and palate (CLP). Design: Retrospective study. Patients and Methods: The study included individuals older than 16 years with CLP, who were scheduled for repositioning of the maxilla by Le Fort I osteotomy, and those with class III malocclusion with maxillary hypoplasia, who were scheduled for Le Fort I osteotomy. The measurements made in the area of the cleft of individuals with CLP were compared with both the side with no cleft and those with class III malocclusion with maxillary hypoplasia. A total of 11 measurements were made on the axial section parallel to the Frankfurt Horizontal plane, corresponding to the lower 1/5 of the distance between the infraorbital foramen and the anterior nasal spine. Results: There were significant differences both in the comparisons made between the individuals with CLP and those without CLP in terms of the canal-anterior alveolar crest (G) and sinus-anterior alveolar crest (L) measurements ( P < .05). The mean measurement values showed that the measurement results were higher in individuals with CLP in general. Conclusion: In conclusion, we believe that there might be difficulties both in osteotomy and down fracture stages during Le Fort I osteotomies performed in individuals with CLP.

Middle and Lower Facial Soft Tissue Changes after Maxillary Advancement through Conventional or High Le Fort I Osteotomy: A Case Series Study

2019 ◽  
Author(s):  
Ramin Foroughi ◽  
Oveis Khakbaz ◽  
Mehrdad Maneshi
Keyword(s):  
Case Series ◽  
Mean Difference ◽  
Class Iii ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Maxillary Advancement ◽  
Tissue Changes ◽  
Group 2 ◽  
Le Fort I ◽  
Group 1

Introduction Maxillary advancementis applied extensively for malocclusion class III correction.This procedure is done using one of the two methods, Conventional or High. Maxilla moves in both vertical and horizontal and only in the horizontal directions in Conventional and High method respectively, so expecting a difference in facialsoft tissue changes. In present study is a case series that describes this issue. Materials and Methods: The cases included 30 patients with class III malocclusion due to maxillary deficiency, whom underwent Le Fort I osteotomy for maxillary advancement in Shahid Beheshti Hospital in Babol, Iran during 1995 to 1995. According to surgical technique, the cases were placed in group 1 (Conventional) or group 2 (High). Maxillary advancement and changes in hard and soft tissue of the middle and lower facial regions where measured through tracing on the lateral cephalometry. Intra-group and inter-group statistical comparisons were done using SPSS20 software at significance level as 0.05. Result: The pre-surgical mean size of SNA, SNB, nasolabial and mentolabial angles was similar in two groups. In all patients, after surgery, SNA angle size was increased and SNB، nasolabial and Mentolabial angles size were decreased. The mean value of these change was similar in two groups. In group 2, the displacement of point A ‘(mean difference: 1.30 mm) and Labrale Superius (mean difference: 1.40 mm) were significantly more than group 1. The amount of displacement of SN (mean difference: 1.30 mm), Labrale Inferius (mean difference: 0.88 mm) and Pogonion (mean difference: 0.23 mm) points in group 2 was higher than that of group 1, but this difference was not statistically significant. Conclusion: It is needed strong evidence for decision about selecting High or Conventional approach maxillary advancement in terms of facial aesthetic aspects. So, further studies with larger sample sizes and cohort or quasi-experimental design is suggested

Traumatic Arteriovenous Malformation following Maxillary Le Fort I Osteotomy

2008 ◽  
Vol 45 (3) ◽  
pp. 329-331 ◽  
Author(s):  
I. M. Smith ◽  
P. J. Anderson ◽  
M. J. Wilks ◽  
D. J. David
Keyword(s):  
Arteriovenous Malformation ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Rare Complication ◽  
Le Fort I Osteotomy ◽  
Le Fort ◽  
Le Fort I

Objective: Complications following maxillary Le Fort I osteotomy are rare. The authors present the rare complication of an arteriovenous malformation following such a procedure in a 25-year-old woman with a cleft lip and palate that was treated successfully with radiologically guided embolization.

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

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.

Severe late-onset epistaxis following le Fort I osteotomy: angiographic localization and embolization

1988 ◽  
Vol 102 (3) ◽  
pp. 260-263 ◽  
Author(s):  
Neil B. Solomons ◽  
Ray Blumgart
Keyword(s):  
Late Onset ◽  
Maxillofacial Surgery ◽  
Severe Trauma ◽  
Maxillofacial Trauma ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Le Fort I Osteotomy ◽  
Artery Ligation ◽  
Le Fort ◽  
Le Fort I

AbstractEpistaxis following maxillofacial trauma or maxillofacial surgery is uncommon. It usually occurs within 24 hours of the injury and can usually be controlled by packing. Rarely internal maxillary artery ligation is necessary and embolization has been used in some cases of severe trauma.We present a case of severe late-onset epistaxis following Le Fort I osteotomy. The diagnostic approach and treatment are discussed.

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