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[Subarachnoid hemorrhage as a complication of Le Fort I osteotomy]

Ai Sano1, Satoshi Taie, Ikuo Uekita

  • 1Department of Anesthesiology & Emergency Medicine, Faculty of Medicine, Kagawa University, Kagawa 761-0793.

Masui. the Japanese Journal of Anesthesiology
|January 25, 2007
PubMed

Insights

Le Fort I osteotomy can cause serious intracranial vascular injuries like subarachnoid hemorrhage (SAH) and carotid cavernous fistula (CCF). Prompt treatment with coil embolization and hypothermia led to a good recovery, highlighting the need to monitor for bleeding during surgery.

Area of Science:

  • Neurosurgery
  • Oral and Maxillofacial Surgery
  • Vascular Surgery

Background:

  • Le Fort I osteotomy is a surgical procedure used to correct midface hypoplasia, often associated with cleft lip and palate repair.
  • Intracranial vascular complications are rare but serious risks associated with craniofacial surgeries.

Observation:

  • A 16-year-old male undergoing Le Fort I osteotomy for cleft lip and palate experienced massive bleeding (>1000 ml) post-fracture.
  • Postoperatively, the patient presented with anisocoria and left-sided hemiparesis, indicating potential neurological compromise.

Findings:

  • Computed tomography (CT) and angiography confirmed the presence of carotid cavernous fistula (CCF) and subarachnoid hemorrhage (SAH).
  • The patient underwent successful coil embolization for the CCF and therapeutic hypothermia for the SAH.

Implications:

  • Unexpected intraoperative hemorrhage during Le Fort I osteotomy should raise suspicion for intracranial vascular injury.
  • Early diagnosis and intervention, including endovascular techniques and neuroprotective measures, are crucial for favorable outcomes in such cases.

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