Embolization of Pseudoaneurysm of the Internal Maxillary Artery After Orthognathic Surgery

Abstract

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures

“…Therefore, every brisk postoperative epistaxis must be suspected to originate from a pseudoaneurysm, certainly if the interval between the surgery and the epistaxis is prolonged. AVELAR et al reported no massive bleeding from the oral cavity upon physical examination of the patients 13 . In the present cases in which no bleeding site was identified during re-exploration or arteriography, massive bleeding was observed through both the oral and the nasal cavities.…”

“…The cases described in this report occurred within the first 14 postoperative days, as in most patients with this condition 11 . In a review of epistaxis due to pseudoaneurysm after Le Fort I osteotomy, AVELAR et al 13 . demonstrated that these pseudoaneurysms occur 3 days to 8 months after the osteotomy.…”

“…Lanigan has devoted numerous articles to exploring the vascular complications of Le Fort I osteotomy 9-12 , including early and delayed haemorrhage associated with Le Fort I osteotomies 10 . Epistaxis has been reported as a sign of postoperative excessive haemorrhage after a Le Fort I osteotomy without identification of the offending vessel 12 , or can be due to a pseudoaneurysm 13,14 or an arteriovenous fistula of the maxillary artery 15,16 . Haemorrhagic complications are thought to be linked to the use of pterygoid chisels for pterygomaxillary disjunction 17 and are reported more frequently in conjunction with the correction of syndromal maxillary hypoplasia 2 .…”

Horizontal Maxillary Osteotomy Approach for Resection of Juvenile Nasopharyngeal Angiofibroma

“…The surgeries were performed with relative ease, leading to minimal bleeding, especially when preoperative embolization was performed. 16 In addition, the procedure offered a wide surgical exposure, with good access to voluminous tumors, including those with intracranial extension. We believe that the resection of the posterior wall of the maxillary sinus allows a direct access to the vascular pedicle of the JA, thus permitting to control the vascular pedicle and facilitating hemostasis and total removal of the tumor.…”

Endovascular management of postoperative pseudoaneurysms of the external carotid artery

“…20 Life-threatening hemorrhage is a rare complication after Le Fort I osteotomy. [21][22][23] The vessel most commonly involved in false aneurysms following mandibular surgery is the IMA. 22 Facial artery pseudoaneurysms were also described following maxillofacial as well as dentistry procedures.…”