Cranial nerve injuries in Le Fort I osteotomy: a systematic review

Alves, Joana Maria dos Santos; Alves, Bruno Wesley de Freitas; Costa, Ana Carolina de Figueiredo; Carneiro, Bárbara Gressy Duarte Souza; Sousa, Luane Macêdo de; Gondim, Delane Viana

doi:10.1016/j.ijom.2018.11.012

Cited by 18 publications

(22 citation statements)

References 70 publications

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Section: Discussionmentioning

confidence: 99%

“…However, if excessive force for the downfracture is needed, previous osteotomies probably were inappropriately made, and the pterygomaxillary separation can be completed with multiple unfavorable fracture trajectories, which are associated with direct and indirect neurovascular damage. 4 Complication rates range from 6% to 9%, most commonly including hemorrhages, infections, malocclusions, tooth loss, maxillary necrosis, and relapse. [2][3][4][5] Pseudoaneurysms, arteriovenous fistulas, decreased visual acuity, and blindness are rare complications.…”

Section: Discussionmentioning

confidence: 99%

“…4 Complication rates range from 6% to 9%, most commonly including hemorrhages, infections, malocclusions, tooth loss, maxillary necrosis, and relapse. [2][3][4][5] Pseudoaneurysms, arteriovenous fistulas, decreased visual acuity, and blindness are rare complications. [6][7][8][9] A PubMed database search using the terms "stroke" and "orthognathic surgery" retrieved 11 articles, but most were related to facial sensitivity to brush stroke stimuli or chewing strokes performance, and none mentioned neurological strokes.…”

Section: Discussionmentioning

confidence: 99%

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Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Bulgarelli

Goldenberg

Loureiro

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Bulgarelli

Goldenberg

Loureiro

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…However, inflammatory changes at the apex of the orbit during osteotomy of the pterygomaxillary junction could have been responsible for optic nerve damage 3,5,6. The general treatment modality was steroid pulse therapy, which has shown efficacy in certain cases 9…”

Section: Discussionmentioning

confidence: 99%

“…Few reports have examined blindness and visual impairment following Le Fort osteotomies for syndromic craniosynostosis 1–9. Blindness, following its occurrence, places a major burden on quality of life; therefore, this impairment is considered a serious complication.…”

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confidence: 99%

Factors Affecting Optic Nerve Damage in Le Fort III Osteotomy: A Retrospective Study

Noto

Sakahara

Sakamoto

et al. 2022

Journal of Craniofacial Surgery

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The causes of visual impairment following Le Fort osteotomy for syndromic craniosynostosis have not been completely elucidated. The authors investigated the potential causes and means of prevention of optic nerve damage, with particular emphasis on intraoperative blood transfusion volume and operating time. This retrospective study evaluated patients who underwent Le Fort III osteotomy for syndromic craniosynostosis between 2000 and 2020. Data on pupillary reflex, pupil size, operating time, blood transfusion, age at time of surgery, sex, and syndrome type were obtained from medical records. Univariate analysis and multivariate analysis with the level of statistical significance set at P<0.05. For the 86 patients included, the mean values of operating time, amount of blood transfusion based on body weight, amount of blood transfusion per body weight per hour, and age were 6.0 hours (range: 3.5–12.3 h), 30.5 mL/kg (range: 0–322 mL/kg), 5.14 mL/kg/h (range: 0–35.7 mL/kg/h), and 10.0 years (range: 4–38 y), respectively. Crouzon, Apert, and Pfeiffer syndromes were observed in 49, 29, and 8 patients, respectively. Abnormal pupillary findings were observed in 27 patients of whom 25 showed no abnormalities in subsequent visual function and 2 developed blindness. Abnormal pupillary findings correlated with the amount of blood transfused per body weight (P=0.0082) and amount of blood transfused per body weight per hour (P=0.0052). As demonstrated in this study, increased intraoperative bleeding and amount of blood transfused were associated with optic nerve damage, particularly during acute bleeding. Prompt inspection of the pupils following surgery is therefore warranted.

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Orthognathic Surgery

Drew¹

2022

Management of Complications in Oral and Maxillofacial Surgery

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Cranial nerve injuries in Le Fort I osteotomy: a systematic review

Cited by 18 publications

References 70 publications

Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Factors Affecting Optic Nerve Damage in Le Fort III Osteotomy: A Retrospective Study

Orthognathic Surgery

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