Vascular complications related to Le Fort I osteotomy: a scoping review

Le Fort I (LFI) osteotomy represents a secure procedure employed for correcting facial deformities and may be coupled with other facial osteotomies. However, notwithstanding professional proficiency, this technique is not exempt from issues or morbidities. Therefore, the objective of this study was to relate the types of vascular complications associated with LFI.

A scoping review was conducted with published articles up to April 2024 sourced from PubMed, LILACS, EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar. The analyzed data comprised: i) comprehensive details pertaining to each vascular lesion associated with LFI; and ii) pertinent anatomical characteristics along with their implications.

A total of 2,415 papers were identified. After removing duplicates and applying the inclusion and exclusion criteria, 33 studies were selected. All included patients had dentofacial deformities. The observed vascular lesions or alterations included: pseudoaneurysm, arteriovenous fistula, section or laceration, maxillary avascular necrosis, internal carotid artery dissection, middle cerebral artery ischemia, and cervicofacial hematoma. Notably, pseudoaneurysm emerged as the most prevalent complication. The surgical features associated with these complications included the incision of the maxillary bone, extending upwards from the pterygomaxillary junction to the pyriform aperture and involving the lateral walls of the nasal cavity. Additionally, disruption of the nasal septum was noted. The internal maxillary artery and its terminal branches are the most exposed to the surgical trauma.

Understanding the potential complications, their clinical presentation, diagnostic methodologies, and management options is of paramount importance. Moreover, a multidisciplinary approach is frequently required to effectively address these complexities.