title: Massive repeated nose bleeding after bimaxillary osteotomy.
abstract: In LeFort I surgery, the separation of the pterygomaxillary junction is done by osteotomy. Although the osteotome is positioned too close to the maxillary artery and its branches during pterygomaxillary separation, postoperative complications from vascular injuries are uncommon. We describe an unusual occurrence of a maxillary artery pseudoaneurysm after LeFort I and bilateral sagittal split osteotomies for maxillary advancement and mandibular setback as well as (anterior sliding) genioplasty. In a patient with class III occlusion and midface retrusion, the significant bleeding began 10 days postoperatively, which was controlled by anterior and posterior nasal packing. The bleeding recurred 28 days after surgery; thus, vascular anatomy in the pterygomaxillary area is reviewed, pseudoaneurysm was diagnosed on selective carotid angiography and successfully treated by embolization; and 2-year follow up was uneventful.
authors.affiliation: Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran. ocrt@sina.tums.ac.ir
authors.forename: Ali
authors.initials: A
authors.lastname: Manafi
authors.forename: Hossein
authors.initials: H
authors.lastname: Ghenaati
authors.forename: Farideh
authors.initials: F
authors.lastname: Dezham
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Arshad
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000209:etiology*; D016461:Chemoembolization, Therapeutic; D004844:Epistaxis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D008334:Mandible / Q000601:surgery; D008438:Maxillary Artery / Q000293:injuries*; D010027:Osteotomy; D019340:Osteotomy, Le Fort / Q000009:adverse effects*