Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies

Girard, Alisa O.; Lopez, Christopher D.; Chen, Jonlin; Perrault, David; Desai, N.R. Mamle; Bruckman, Karl C.; Bartlett, Scott P.; Yang, Robin

doi:10.1177/19433875211008086

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…This is typically encountered with other conditions such as fibromas, hemangiomas, malignant melanomas, hereditary hemorrhagic telangiectasis, and inflammatory granulomas [ 11 ]. Oozing of blood is frequently encountered in orthognathic surgeries as epistaxis, but not as hemolacria [ 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

A rare complication of hemolacria after Le fort I osteotomy: a case presentation

Helal

Gaber

El-Kassaby

2022

Maxillofac Plast Reconstr Surg

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Background Nasolacrimal duct obstruction (NDO) is a common pathology preventing the proper drainage of the tears, and its main symptom is epiphora. Secondary acquired nasolacrimal duct obstruction (SANDO) can be due to a variety of causes including infection, trauma, or neoplasms. It has been reported to occur with different forms of maxillofacial trauma, especially Le Fort II, Le Fort III, naso-orbital-ethmoidal, and orbital floor fractures. Case presentation A 20-year-old Egyptian female presented to correct a facial disharmony due to a cleft lip and palate defect. The patient reported a history of congenital NDO and had deficient lateral nasal walls. Bimaxillary surgery was planned, including a Le Fort I osteotomy for the maxilla and bilateral sagittal split osteotomy for the mandible. The surgery was uneventful, but the patient complained from bloody tears or hemolacria few days postoperatively. This complication began to cease spontaneously after 2 days and completely recovered after 4 days. Conclusion Hemolacria is an infrequent finding after maxillofacial surgeries and may be associated with CLP surgeries more than other surgeries. In this case, it was easily managed, and surgeons should be more aware of it to try to prevent its occurrence.

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Section: Discussionmentioning

confidence: 99%

A rare complication of hemolacria after Le fort I osteotomy: a case presentation

Helal

Gaber

El-Kassaby

2022

Maxillofac Plast Reconstr Surg

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“…This incision passes through the walls of the maxillary sinuses and the nasal septum on both sides [1]. The Le Fort I osteotomy is often chosen because of its short duration, simple anatomical approach, consistent long-term outcomes, and adaptable method of repositioning the maxilla in threedimensional space [4].…”

Section: Introductionmentioning

confidence: 99%

“…The most common complication of OS is intraoperative and post-operative bleeding, which can be lifethreatening [4]. Moreover, surgical alterations to the anatomy and physiology of the maxillary sinuses may lead to sinus inflammation and post-operative infection [5].…”

Section: Introductionmentioning

confidence: 99%

Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy

Mendes,

Bortoli,

Zaleski

et al. 2024

BMC Oral Health

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Introduction Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. Methods Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3–6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). Results The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients’ young and healthy condition. Conclusion There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.

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Effect of hematoma on early degradation behavior of magnesium after implantation

Yusa,

Shimizu,

Hayashi

et al. 2024

Biomed. Mater.

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The corrosion of magnesium (Mg)-based bioabsorbable implanting devices is influenced by implantation environment which dynamically changes by biological response including wound healing. Understanding the corrosion mechanisms along the healing process is essential for the development of Mg-based devices. In this study, a hematoma model was created in a rat femur to analyze Mg corrosion with hematoma in the early stage of implantation. Pure Mg specimen (99.9%, φ1.2×6 mm) was implanted in rat femur under either hematoma or non-hematoma conditions. After a designated period of implantation, the specimens were collected and weighed. The insoluble salts formed on the specimen surfaces were analyzed using scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Raman spectroscopy on days 1, 3, and 7. The results indicate that hematomas promote Mg corrosion and change the insoluble salt precipitation. The weight loss of the hematoma group (27.31 ± 5.91 µg/mm2) was significantly larger than that of the non-hematoma group (14.77 ± 3.28 µg/mm2) on day 7. In the non-hematoma group, carbonate and phosphate were detected even on day 1, but the only latter was detected on day 7. In the hematoma group, hydroxide was detected on day 1, followed by the formation of carbonate and phosphate on days 3 and 7. The obtained results suggest the hypoxic and acidic microenvironment in hematomas accelerates the Mg corrosion immediately after implantation, and the subsequent hematoma resorption process leads to the formation of phosphate and carbonate with organic molecules. This study revealed the risk of hematomas as an acceleration factor of the corrosion of Mg-based devices leading to the early implant failure. It is important to consider this risk in the design of Mg-based devices and to optimize surgical procedures controlling hemorrhage at implantation and reducing unexpected bleeding after surgery.

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Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies

Cited by 4 publications

References 37 publications

A rare complication of hemolacria after Le fort I osteotomy: a case presentation

A rare complication of hemolacria after Le fort I osteotomy: a case presentation

Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy

Effect of hematoma on early degradation behavior of magnesium after implantation

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