Carotid artery thrombosis after elective mandibular and maxillary osteotomies

This is believed to be the first reported case of carotid artery thrombosis after elective maxillary or mandibular osteotomy. The most likely cause was a sudden, sharp blow to the right carotid artery region either when the mandibular split was completed or when the maxillary tuberosity was separated. The blow was associated with neck hyperextension and some lateral flexion. In a patient with tight, underdeveloped soft tissue, the resultant intimal tear caused thrombosis of the artery. Although this event is associated with a 40% mortality and further 52% serious morbidity, our patient has regained nearly full neurological function--probably thanks to a competent circle of Willis that allowed adequate collateral flow to the brain.