[Rare complication after Le Fort I osteotomy]

Area of Science:

• Oral and Maxillofacial Surgery
• Otolaryngology
• Anatomy

Background:

• Le Fort I osteotomy is a surgical procedure to correct midface hypoplasia.
• Eustachian tube (ET) dysfunction is a potential complication, though rare after this procedure.
• This report details a unique case of persistent ET dysfunction post-osteotomy.

Observation:

• A 22-year-old female presented with recurrent left-sided Eustachian tube malfunction and middle ear effusions after Le Fort I osteotomy for maxillary retrognathism.
• Conservative treatments including adenotomy, tonsillectomy, and tympanostomy tube insertion failed to resolve the symptoms.
• Imaging revealed a significant forward dislocation of the left pterygoid hamulus and apparent damage to the tensor veli palatini muscle.

Findings:

• The study identified a direct correlation between the surgical trauma and the observed anatomical changes.
• Forward dislocation of the pterygoid hamulus and tensor veli palatini muscle damage were the primary findings.
• These sequelae were implicated as the cause of the unilateral Eustachian tube dysfunction.

Implications:

• This case highlights a previously under-recognized complication of Le Fort I osteotomy.
• It emphasizes the importance of careful surgical technique to avoid injury to adjacent structures like the pterygoid hamulus and tensor veli palatini.
• Understanding these specific anatomical sequelae can improve diagnosis and management of post-surgical Eustachian tube dysfunction.