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Helal MS, Gaber RM, El-Kassaby M. A rare complication of hemolacria after Le fort I osteotomy: a case presentation. Maxillofac Plast Reconstr Surg 2022; 44:29. [PMID: 36115900 PMCID: PMC9482558 DOI: 10.1186/s40902-022-00359-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nasolacrimal duct obstruction (NDO) is a common pathology preventing the proper drainage of the tears, and its main symptom is epiphora. Secondary acquired nasolacrimal duct obstruction (SANDO) can be due to a variety of causes including infection, trauma, or neoplasms. It has been reported to occur with different forms of maxillofacial trauma, especially Le Fort II, Le Fort III, naso-orbital-ethmoidal, and orbital floor fractures. CASE PRESENTATION A 20-year-old Egyptian female presented to correct a facial disharmony due to a cleft lip and palate defect. The patient reported a history of congenital NDO and had deficient lateral nasal walls. Bimaxillary surgery was planned, including a Le Fort I osteotomy for the maxilla and bilateral sagittal split osteotomy for the mandible. The surgery was uneventful, but the patient complained from bloody tears or hemolacria few days postoperatively. This complication began to cease spontaneously after 2 days and completely recovered after 4 days. CONCLUSION Hemolacria is an infrequent finding after maxillofacial surgeries and may be associated with CLP surgeries more than other surgeries. In this case, it was easily managed, and surgeons should be more aware of it to try to prevent its occurrence.
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Affiliation(s)
- May S. Helal
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, 21531 Egypt
| | - Ramy M. Gaber
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Marwa El-Kassaby
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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2
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Girard A, Lopez CD, Chen J, Perrault D, Desai N, Bruckman KC, Bartlett SP, Yang R. Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies. Craniomaxillofac Trauma Reconstr 2022; 15:147-163. [PMID: 35633764 DOI: 10.1177/19433875211008086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Study Design This is a literature review with 3 case studies. Objective Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to 1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, 2) identify management approaches, and 3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis. Methods A literature search of PubMed was conducted and 28 cases from 17 studies were assessed. Results Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases. Conclusions As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability.
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Affiliation(s)
- Alisa Girard
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Plastic Surgery, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonlin Chen
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Perrault
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Nikhil Desai
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl C Bruckman
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Akca Caglar A, Akca H, Kurt F, Akcan Yildiz L, Nalcacioglu P, Buyukkoc O, Dibek Misirlioglu E. Sudden-onset haemolacria in an adolescent girl. Paediatr Int Child Health 2021; 41:295-299. [PMID: 34275424 DOI: 10.1080/20469047.2021.1949563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.
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Affiliation(s)
- Ayla Akca Caglar
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Halise Akca
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Funda Kurt
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Leman Akcan Yildiz
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | | | - Onur Buyukkoc
- Department of Otorhinolaryngology, Ankara City Hospital, Ankara, Turkey
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Loureiro RM, Collin J, Sumi DV, Araújo LC, Murakoshi RW, Gomes RLE, Daniel MM. Postoperative CT findings of orthognathic surgery and its complications: A guide for radiologists. J Neuroradiol 2021; 49:17-32. [PMID: 33864896 DOI: 10.1016/j.neurad.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
Orthognathic surgery is the standard procedure to correct congenital, developmental, or acquired dentofacial deformities. The maxillomandibular relationship corrected by orthognathic surgery can improve facial esthetics, masticatory function, articulation, and breathing. The most common types of osteotomies include the combination of Le Fort I osteotomy, bilateral sagittal split mandibular ramus osteotomy, and genioplasty. High-resolution low-dose computed tomography is useful for evaluating the facial skeleton and soft tissues after surgery as well as for depicting a variety of possible complications. This article reviews the postoperative imaging findings of the most common orthognathic surgeries and their potential complications on multidetector-row computed tomography.
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Affiliation(s)
- Rafael Maffei Loureiro
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - John Collin
- Bristol Royal Infirmary, Department of Oral and Maxillofacial Surgery, Marlborough Street, Bristol BS2 8HW, United Kingdom.
| | - Daniel Vaccaro Sumi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Luziany Carvalho Araújo
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Rodrigo Watanabe Murakoshi
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Regina Lucia Elia Gomes
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
| | - Mauro Miguel Daniel
- Hospital Israelita Albert Einstein, Department of Radiology, Av. Albert Einstein, 627/701, 05652-900 São Paulo, SP, Brazil.
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Drake AE, Packer CD. Epistaxis Complicated by Hemolacria: A Case Report. Clin Med Res 2020; 18:99-101. [PMID: 32816989 PMCID: PMC7428209 DOI: 10.3121/cmr.2020.1566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/18/2022]
Abstract
Hemolacria is a rare complication of epistaxis treated with nasal compression or tamponade. We report the case of a man, aged 81 years, with end-stage renal disease who developed hemolacria after insertion of a "Rhino Rocket" nasal tamponade device to treat persistent epistaxis. The hemolacria resolved after treatment with intranasal oxymetazoline. In the setting of epistaxis with nasal tamponade, hemolacria is thought to be caused by retrograde flow from the inferior nasal turbinates via an anatomic connection with the lacrimal system, with passage through the valves of Hasner and Rosenmüller to the lacrimal ducts. Hemolacria is very rare even in severe cases of epistaxis; we postulate that only patients with either congenital absence or acquired incompetence of the lacrimal valves are predisposed to hemolacria after treatment of epistaxis with a tamponade device. Physicians should be aware that hemolacria in the setting of epistaxis is usually a self-limited condition that can be treated with conservative measures to control nasal hemorrhage.
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Affiliation(s)
- Anne E Drake
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Clifford D Packer
- Case Western Reserve University School of Medicine, Cleveland, OH
- VA Medical Center, Cleveland, OH
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Billoir P, Feugray G, Chrétien MH, Fresel M, Le Cam Duchez V. [Bloody tears: About a case and a review of the literature]. Rev Med Interne 2019; 41:339-342. [PMID: 31882188 DOI: 10.1016/j.revmed.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/25/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemolacria is a rare hemorrhagic syndrome characterized by bloody tears. The most common etiologies are inflammation, infection or laceration. However, other rarer diseases may also cause this clinical manifestation. CASE REPORT We describe the case of a 14-year-old male patient hospitalized for hemolacria. A history of von Willebrand disease was present in his family, diagnosed in his mother and sister, but absent in our patient. A vitamin C dosage was obtained in our patient and revealed scurvy consecutive to malnutrition. After having excluded other bleeding symptoms like bruises we retained vitamin C deficiency as the etiology of the hemorrhagic syndrome. CONCLUSION Bloody tears are a rare clinical manifestation and the etiology may be difficult to determine. Bloody tears are a rare clinical manifestation of hemorrhagic syndrome. To determine the underlying etiology, screening should consider all possible causes including the rarest.
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Affiliation(s)
- P Billoir
- Vascular hemostasis unit, Normandie Univ, UNIROUEN, Inserm U1096, Rouen university hospital, 76000 Rouen, France.
| | - G Feugray
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - M H Chrétien
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - M Fresel
- Vascular hemostasis unit, Rouen university hospital, 76000 Rouen, France
| | - V Le Cam Duchez
- Vascular hemostasis unit, Normandie Univ, UNIROUEN, Inserm U1096, Rouen university hospital, 76000 Rouen, France
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Tamiolakis P, Kalyvas D, Arvanitidou I, Vlachaki A, Tosios KI, Sklavounou-Andrikopoulou A. Palatal schwannoma in a young female patient: report of a case and review of the literature. Eur Arch Paediatr Dent 2018; 19:279-285. [PMID: 29882201 DOI: 10.1007/s40368-018-0349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 05/14/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND A few cases of oral schwannomas in paediatric patients have appeared in the literature so far; however, there are no studies focusing solely on paediatric oral schwannomas. The aim of this study is to report a case of palatal schwannoma in a young female patient and review the pertinent literature on oral schwannomas in paediatric patients. CASE REPORT A 12-year-old girl presented with a growing swelling of 2 weeks duration on the hard palate. With a provisional diagnosis of a salivary gland neoplasm an incisional biopsy was performed under local anesthesia and the histologic examination disclosed an Antony A type schwannoma. TREATMENT Complete surgical resection of the lesion was performed under local anaesthesia through a palatal mucosa incision and paraffin gauze was sutured on the surgical area for protection during secondary healing. The bone underlying the tumor was normal. The postoperative period was uneventful and 2 weeks after excision the gauze were removed. FOLLOW-UP There have been no signs of recurrence during a 18-month follow up period. CONCLUSION A palatal swelling in a child or adolescent may represent a neoplasm, such as a schwannoma and requires careful clinical and radiographic evaluation of the dentition.
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Affiliation(s)
- P Tamiolakis
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece.
| | - D Kalyvas
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece
| | - I Arvanitidou
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece
| | - A Vlachaki
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece
| | - K I Tosios
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece
| | - A Sklavounou-Andrikopoulou
- Department of Oral Medicine and Pathology, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27, Athens, Greece
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MacIntosh RB, Shivapuja PK, Warren ED. Total Maxillary Alveolar Osteotomy: Surgical Technique and Review of Its Efficacy. J Oral Maxillofac Surg 2018; 76:1097.e1-1097.e18. [PMID: 29378176 DOI: 10.1016/j.joms.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The total maxillary alveolar osteotomy (TMxAO) is not commonly used to manage maxillary skeletal deformities. This article describes the technique, reviews its stability, and discusses its advantages over the more popular Le Fort I osteotomy. MATERIALS AND METHODS A series of 177 TMxAO patients satisfying the inclusion criteria from a cadre of 234 patients undergoing TMxAO between 1985 and 1993 were evaluated in a retrospective cohort study regarding achievement of predicted anatomic movements, stability of skeletal results, and preservation of inter-alar dimension. The patients were evaluated early postoperatively and at 11 to 14 months postoperatively, and the data were exposed to the Shapiro-Wilk test and analysis of variance and analyzed using SPSS software (version 21; IBM, Armonk, NY) at the 99% level of confidence (P ≤ .01). RESULTS Only in 58% of patients did the designed millimetric study model changes correspond precisely to the millimetric changes disclosed in a comparison of preoperative and early postoperative cephalograms. Comparison of early and late postoperative cephalograms, with infrequent exceptions, described millimetric instabilities of less than 2 mm and angular instabilities of less than 2°. Despite 2 significant outliers, the average inter-alar instability as determined by direct measurement was 0.19 mm. CONCLUSIONS This study suggests that the TMxAO compares favorably in stability with the Le Fort I osteotomy as recorded in the literature and, in terms of versatility, mobility of segments, avoidance of anatomic hazard, and preservation of nasal width, offers advantages in comparison.
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Affiliation(s)
- Robert B MacIntosh
- Clinical Professor and Scholar in Residence, Department of Oral and Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, Detroit, MI.
| | - Prasanna-Kumar Shivapuja
- Orthodontic Consultant, Oral and Maxillofacial Surgery Residency Program, St John Health System, Detroit, MI
| | - Erik D Warren
- Private Practice, Cleveland, OH; and Formerly, Chief Resident, Oral and Maxillofacial Surgery, St John Health System, Detroit, MI
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Vera-Sirera B, Fernades-Ciacha L, Floria LM, Vera-Sempere F. Palatal ancient schwannoma: optical, immunohistochemical and ultrastructural study with literature review. Eur Arch Otorhinolaryngol 2017; 274:4195-4202. [PMID: 28975399 DOI: 10.1007/s00405-017-4759-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
Schwannoma or neurilemmoma is a benign encapsulated slow-growing tumor that originates from a Schwann cell of a nerve, and is rare at intraoral locations. Different histological variants of schwannomas have been described, of these degenerative or ancient schwannoma is probably one of the least common in the oral cavity with only 16 previously reported cases, of which only one has been described in palatal location. Although ancient schwannoma shows particular characteristics, it is difficult to diagnose based on clinical and imaging appearance alone; as a result, morphological examination assisted by ancillary techniques is necessary to establish a definite diagnosis. We present a clinicopathological description of this rare variant of schwannoma, located in an unusual intraoral site, of a 26-year-old female. We illustrate the optical, immunohistochemical and ultrastructural characterization that aid diagnosis, as well as providing a review of the relevant published data of this unusual tumor.
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Affiliation(s)
| | - Lorena Fernades-Ciacha
- Department of Oral and Maxillofacial Surgery, La Fe University Hospital, Valencia, Spain
| | - Luis M Floria
- Department of Stomatology, Valencia University, Valencia, Spain
| | - Francisco Vera-Sempere
- Department of Pathology, Valencia University and La Fe University Hospital, Avda. Fernando Abril Martorell 106, Torre A, 2ª Planta, 46026, Valencia, Spain.
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Cakarer S, Keskin B, Isler S, Cansiz E, Uzun A, Keskin C. Complications associated with surgically assisted rapid palatal expansion without pterygomaxillary separation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017. [DOI: 10.1016/j.jormas.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dergin G, Aktop S, Varol A, Ugurlu F, Garip H. Complications related to surgically assisted rapid palatal expansion. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:601-7. [DOI: 10.1016/j.oooo.2015.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
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Screw implantation in the globe: the risk of delayed hardware migration from craniofacial repair. J Craniofac Surg 2013; 24:1650-2. [PMID: 24036744 DOI: 10.1097/scs.0b013e3182942969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Plating system modification has enabled the use of rigid fixation in younger patients having maxillofacial surgery. One of the common reported complications of the use of plates and screws in children is screw migration due to skeletal maturation. Ophthalmic complications due to maxillofacial surgery reported to date include oculomotor and abducens palsies, lacrimal damage and vision loss due to infection, retrobulbar hemorrhage, and compartment syndrome. We describe a complication unique to screw migration resulting in orbital fixation and near-globe rupture in a patient with Treacher Collins syndrome. We hope to alert our colleagues to the potential risk of screw and hardware migration and breakage, particularly in the setting of craniofacial surgery performed on a child before maturation of craniofacial osseous structures.
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Steel BJ, Cope MR. Unusual and Rare Complications of Orthognathic Surgery: A Literature Review. J Oral Maxillofac Surg 2012; 70:1678-91. [DOI: 10.1016/j.joms.2011.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 05/03/2011] [Accepted: 05/09/2011] [Indexed: 10/17/2022]
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