Delayed presentation of pseudoaneurysm after Le Fort I osteotomy.
Although the osteotome is positioned in close vicinity to the maxillary artery and its branches during ptergomaxillary separation in a Le Fort I osteotomy, postoperative complications from vascular injuries are rare. The following report describes an unusual occurrence of a maxillary artery pseudoaneurysm following a Le Fort I and bilateral sagittal-split osteotomies for correction of mandibular and maxillary asymmetries in a patient with Goldenhar syndrome. This was recognized 8 months after the procedure when the patient developed acute facial swelling and required an emergent angiogram for uncontrolled bleeding. Vascular anatomy in the ptergomaxillary area is reviewed. A level of suspicion of occult vascular injuries in patients with sudden onset of unilateral facial swelling after orthognathic surgery, even months after the procedure, is recommended.
Bradley
James P
JP
Division of Plastic and Reconstructive Surgery, The University of California, Los Angeles, Los Angeles, California, USA.
Elahi
Mohammed
M
Kawamoto
Henry K
HK
D000293:Adolescent; D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005146:Facial Asymmetry / Q000209:etiology / Q000601:surgery*; D006053:Goldenhar Syndrome / Q000150:complications; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008438:Maxillary Artery / Q000293:injuries*; D019340:Osteotomy, Le Fort / Q000009:adverse effects*