J Korean Assoc Oral Maxillofac Surg.  2019 Dec;45(6):364-368. 10.5125/jkaoms.2019.45.6.364.

An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report

• Park B
• Jang WH
• Lee BK

• KMID: 2467189
• DOI: http://doi.org/10.5125/jkaoms.2019.45.6.364

Abstract

A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

Keyword

Epistaxis; Postoperative complication; Le Fort I osteotomy; Pseudoaneurysm

MeSH Terms

Aneurysm, False
Angiography
Arteries
Blood Vessels
Cautery
Congenital Abnormalities
Epistaxis
Hemorrhage*
Maxillary Artery
Orthognathic Surgery*
Osteotomy*
Postoperative Complications
Postoperative Hemorrhage
Veins

Figure

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  Fig. 1 Images produced three weeks after surgery in the study patient. A. Panoramic x-ray. B. Posteroanterior cephalogram. C. Lateral cephalograms.

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  Fig. 2 Images produced three weeks after surgery in the study patient. A. Computed tomography with contrast. B. Angiogram.

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  Fig. 3 The right posterior lateral nasal artery, a branch of the sphenopalatine artery that was suspected to be the bleeding focus, was electrocauterized. A. The bleeding focus in the study case was observed at the right posterior lateral nasal artery site. B. Bleeding occurred at the focus site when irritated by a suction tip. C. Bleeding was successfully stopped by electrocauterization.

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