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Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not descr...

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Autores principales: Bulgarelli, Luana Lima, Goldenberg, Dov Charles, Loureiro, Rafael Maffei, Gentil, Andre Felix, Morgulis, Roberto Franco, Ribas, Eduardo Carvalhal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390827/
https://www.ncbi.nlm.nih.gov/pubmed/35999886
http://dx.doi.org/10.1097/GOX.0000000000004471
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author Bulgarelli, Luana Lima
Goldenberg, Dov Charles
Loureiro, Rafael Maffei
Gentil, Andre Felix
Morgulis, Roberto Franco
Ribas, Eduardo Carvalhal
author_facet Bulgarelli, Luana Lima
Goldenberg, Dov Charles
Loureiro, Rafael Maffei
Gentil, Andre Felix
Morgulis, Roberto Franco
Ribas, Eduardo Carvalhal
author_sort Bulgarelli, Luana Lima
collection PubMed
description Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits.
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spelling pubmed-93908272022-08-22 Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication Bulgarelli, Luana Lima Goldenberg, Dov Charles Loureiro, Rafael Maffei Gentil, Andre Felix Morgulis, Roberto Franco Ribas, Eduardo Carvalhal Plast Reconstr Surg Glob Open Craniofacial/Pediatric Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits. Lippincott Williams & Wilkins 2022-08-19 /pmc/articles/PMC9390827/ /pubmed/35999886 http://dx.doi.org/10.1097/GOX.0000000000004471 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Craniofacial/Pediatric
Bulgarelli, Luana Lima
Goldenberg, Dov Charles
Loureiro, Rafael Maffei
Gentil, Andre Felix
Morgulis, Roberto Franco
Ribas, Eduardo Carvalhal
Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title_full Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title_fullStr Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title_full_unstemmed Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title_short Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication
title_sort stroke due to orthognathic surgery: case report of a rare complication
topic Craniofacial/Pediatric
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390827/
https://www.ncbi.nlm.nih.gov/pubmed/35999886
http://dx.doi.org/10.1097/GOX.0000000000004471
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