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Botella-Casas G, Marqués-Mateo M, Miragall-Alba L, Río-Vega DM, González-Soler E, Puche-Torres M. Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case. Oral Maxillofac Surg 2024; 28:963-966. [PMID: 37981623 DOI: 10.1007/s10006-023-01197-9] [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: 08/30/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.
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Affiliation(s)
- Gonzalo Botella-Casas
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain.
| | - Mariano Marqués-Mateo
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Luis Miragall-Alba
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Daniela María Río-Vega
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Eva González-Soler
- Department of Anatomy and Embryology, University of Valencia, Valencia, Spain
| | - Miguel Puche-Torres
- Head of Service of Maxillofacial Surgery, Hospital Clinico Universitario of Valencia, INCLIVA, Valencia, Spain
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Zou Y, Yang R, Yeweng SJ, Wu Z. MSCT 3D Analysis of Nasopharyngeal Airway After Le Fort I Maxillary Setback Surgeries. J Craniofac Surg 2024:00001665-990000000-01395. [PMID: 38445867 DOI: 10.1097/scs.0000000000010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/25/2023] [Indexed: 03/07/2024] Open
Abstract
In recent years, maxillary Le Fort I osteotomy setback has been widely applied in correcting maxilla prognathism. In the meantime, airway considerations have attracted more and more attention. The aim of this research was to observe the alteration of nasopharyngeal airway indexes after maxilla setback and offer evidence for the effectiveness and safety of maxillary Le Fort I setback surgeries. As for a retrospective cross-sectional study, 40 patients diagnosed with maxilla prognathism and undergoing maxillary setback surgeries were enrolled. They were grouped by the type of maxillary setback operations as group A (integral maxillary setback, n=19) and group B (segmental maxillary setback, n=21). Multislice computed tomography data were collected 1 week before (T0) and more than 3 months (T1) after surgery. 3D reconstruction and evaluation of the pharyngeal airway were conducted to analyze nasopharyngeal airway index variation before and after surgery and the difference between group A and group B. Preoperative and postoperative nasopharyngeal airway volume showed no statistical significance in group A (P=0.872) and group B (P=0.169) as well as other indexes of the nasopharynx. The comparison of postoperative airway changes between group A and group B also showed no significant difference. Both integral and segmental maxillary Le Fort I osteotomy setbacks have slight impact on nasopharyngeal airway dimensions and are safe within a specific setback range.
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Affiliation(s)
- Yiwen Zou
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
- Department of Oral and Maxillofacial Surgery, Stomatology School and Hospital of Peking University, Beijing, China
| | - Ruicong Yang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
- Department of Orthodontics, Stomatology School and Hospital of Peking University, Beijing, China
| | - San-Jie Yeweng
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
- Department of Orthodontics, School of Stomatology, Wuhan University, Wuhan, PR China
| | - Zhongxing Wu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
- Department of Orthognathic and Cleft Lip and Palate Plastic Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, PR China
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Eberliköse H, Güler AY, Akbarihamed R, Öztürk C, Karasu HA. Comprehensive analysis of lateral nasal wall anatomy to optimize the osteotomy in different skeletal patterns. Surg Radiol Anat 2024; 46:327-332. [PMID: 38438716 DOI: 10.1007/s00276-023-03292-8] [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: 09/28/2023] [Accepted: 12/20/2023] [Indexed: 03/06/2024]
Abstract
PURPOSE Variations in nasal wall anatomy are crucial in patients with dentofacial deformities undergoing Le Fort I osteotomy. These structural variations heighten the potential for complications during surgical procedures. Hence, the study focused on evaluating the differences in the lateral nasal wall anatomy across different skeletal Classes. METHODS This study evaluated 86 patients aged 18-43 years with different skeletal Classes. In the axial images acquired from coronal sections, two angulations and the linear distances of the lateral nasal wall were measured in Class I, II, and III patients. The measurement between the piriform opening and the most anterior point of the greater palatine foramen was evaluated in three parts regarding the osteotomy line. Differences between the skeletal patterns were analyzed using an independent sample t-test and Mann-Whitney U test with a significance level of 0.05. The intra-class correlation coefficient was calculated for inter-observer and intra-observer agreement. RESULTS There was a statistically significant difference between Class I and Class II subjects regarding the anterior lateral nasal wall (p = 0.011) and anterior nasal thickness (a) (0.004). There was a significant difference between Class I and Class III patients regarding anterior nasal thickness (a) (p < 0.001) and total lateral nasal wall length (p < 0.001). CONCLUSION For instance, the measurements of Class III and Class II patients were relatively different from those of the Class I patients. Therefore, preoperative Cone-Beam Computed Tomographic analysis should be performed for each patient prior to Le Fort I osteotomy to ensure that the procedure is performed safely.
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Affiliation(s)
- Hacer Eberliköse
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey.
| | - Arif Yigit Güler
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Raha Akbarihamed
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Caner Öztürk
- Department of Prosthodontics, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
| | - Hakan Alpay Karasu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Medipol University, Ankara, Turkey
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Yun Y, Kurasawa S, Morita M, Kawachi R, Murata H, Sawada S, Kojima Y, Yagi M, Asako M, Iwai H. Postoperative hemorrhage after Le Fort I osteotomy hemostasis with angiographic embolization: report of two cases. J Surg Case Rep 2023; 2023:rjad663. [PMID: 38111488 PMCID: PMC10725792 DOI: 10.1093/jscr/rjad663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
This study reported two cases of acute life-threatening hemorrhage after Le Fort I osteotomy. In both cases, computed tomography and angiography revealed damage to the descending palatine artery, which was successfully treated by angiographic embolization. Although massive hemorrhage after Le Fort I osteotomy is rare, acute hemorrhage from the postoperative area may occur. Angiographic embolization is useful in cases of such hemorrhage from the posterior nasal cavity where endoscopic hemostasis is not possible.
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Affiliation(s)
- Yasutaka Yun
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shiro Kurasawa
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mizuki Morita
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Risaki Kawachi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hideyuki Murata
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shunsuke Sawada
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuka Kojima
- Department of Oral and Maxillofacial Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masao Yagi
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mikiya Asako
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hiroshi Iwai
- Department of Otorhinolaryngology, Head & Neck Surgery, Kansai Medical University, Hirakata, Osaka, Japan
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Pseudoaneurysms and Orthognathic Surgery: A Systematic Review and a Proposed Algorithm of Treatment. J Craniofac Surg 2022; 34:1031-1035. [PMID: 36377043 DOI: 10.1097/scs.0000000000009134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to gather existing evidence regarding the incidence, clinical presentation, and management of pseudoaneurysms (PA) after orthognathic surgery, identify the common blood vessels involved in PA, and propose a treatment algorithm based on current evidence. The protocol for this study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and was registered at the International Prospective Register of Systematic Reviews under the registration number CRD42020205479. Although these are rare, oral and maxillofacial surgeons should consider PA as a possible diagnosis, specifically in the maxillary artery of patients with epistaxis, severe facial edema, and swelling following LeFort I osteotomy.
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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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Psillas G, Dimas GG, Papaioannou D, Savopoulos C, Constantinidis J. Epistaxis in dental and maxillofacial practice: a comprehensive review. J Korean Assoc Oral Maxillofac Surg 2022; 48:13-20. [PMID: 35221303 PMCID: PMC8890961 DOI: 10.5125/jkaoms.2022.48.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022] Open
Abstract
The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.
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Affiliation(s)
- George Psillas
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Grigorios Georgios Dimas
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Despoina Papaioannou
- School of Dentistry, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Academic ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Katsumi Y, Takagi R, Ohshima H. Variations in the venous supply of the floor of the oral cavity: Assessment of relative hemorrhage risk during surgery. Clin Anat 2021; 34:1087-1094. [PMID: 33905588 DOI: 10.1002/ca.23738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 11/08/2022]
Abstract
There is little anatomical evidence about the venous plexus in the floor of the oral cavity, although venous injury can elicit late postoperative bleeding after oral surgery and it is difficult to identify the exact location of such an injury. The aim of this study was to assess the relative risk for venous injury during surgery. We investigated the course patterns of the venous plexus in the floor of the oral cavity and analyzed their relationships to those of the arteries using 23 human cadavers (41 halves) in the anatomy course at Niigata University during 2016-2018. The venous plexus in the floor of the oral cavity comprised the perforating submental vein, the vena comitans of the hypoglossal nerve, the vena comitans of the submandibular duct, the vena comitans of the lingual nerve, the sublingual vein, and the deep lingual vein. Individual variations of this plexus include duplications or absences of some veins. There is a high incidence of a submental branch running above the mylohyoid or perforating submental artery in the sublingual fossa among individuals with the perforating submental vein piercing the mylohyoid muscle, whereas the sublingual artery has a high incidence there when there is no perforating submental vein. The course patterns of arteries in the floor of the oral cavity can be predicted by estimating the course patterns of the submental veins. The course patterns of the submental veins or veins associated with the nerves and submandibular duct need to be carefully considered during surgery.
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Affiliation(s)
- Yuji Katsumi
- Division of Oral and Maxillofacial Surgery, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ristuo Takagi
- Division of Oral and Maxillofacial Surgery, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hayato Ohshima
- Division of Anatomy and Cell Biology of the Hard Tissue, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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