Author/Authors :
Bertossi, Dario G. B. Rossi Policlinic - Departments of Maxillo Facial Surgery and Facial Plastic Surgery, Italy , Malchiodi, Luciano G. B. Rossi Policlinic - Departments of Maxillo Facial Surgery and Facial Plastic Surgery, Italy , Shideh, Ehsani Vita Salute University - San Raffaele Hospital - Department of Dentistry, Italy , Albanese, Massimo G. B. Rossi Policlinic - Departments of Maxillo Facial Surgery and Facial Plastic Surgery, Italy , Portelli, Marco University of Messina - Faculty of Medicine and Surgery - Departments of Dentistry, Italy , Lucchese, Alessandra University of Ferrara - Department of Morphology, Surgery and Experimental Medicine, Italy , Carinci, Francesco University of Ferrara - Department of Morphology,Surgery and Experimental Medicine, Italy , Nocini, Pierfrancesco G. B. Rossi Policlinic - Departments of Maxillo Facial Surgery and Facial Plastic Surgery, Italy
Abstract :
Although the Le Fort I osteotomy is a safe surgical technique, many complications have been reported. We present a case of an extended cervico‑facial haematoma due to delayed bleeding from the terminal branches of the maxillary artery after orthognatic surgery. A 23‑year‑old man was referred to our observation for the surgical correction of a class III asymmetric malocclusion. The patient underwent a Le Fort I osteotomy, with impaction of the maxilla, associated with an Epker mandibular bilateral sagittal split osteotomy, with maxillary advancement and rigid internal fixation of the mandible with four miniplates and another four for the upper maxilla as well. The first post‑surgery day, the patient developed a gradual dispnea together with neck swelling. By second postoperative day, the patient’s general condition improved with a progressive normalization of laboratory tests values. The Computerised Axial Tomography (CAT) scan confirmed a decrease in the parapharyngeal thickening. Total recovery was achieved within two months, the final clinical check showed a healthy appearance with good occlusion. An increased knowledge of the basic biology of the Le Fort I osteotomy, the development of instruments specially designed for the Le Fort I procedure and the use of hypotensive anaesthesia could reduce the morbidity and duration of this procedure.
