Temporary intraoperative maxillary ischaemia in a patient with sickle cell trait during a bimaxillary osteotomy — a case report

Abstract

Background: Impaction of the maxilla during orthognathic surgery results in sliding along the anterior cranial base. Considering the inclination of anterior cranial base, superior repositioning should also result in an anterior movement of the maxilla. The surgical anteroposterior movement of the facial bones implies secondary positional and tensional changes in the attached soft tissues that introduce significant changes in the facial appearance and in the pharyngeal airway space. Objective: To evaluate changes in cephalometric measurements of the PSAS before and after superior impaction of the maxilla. Methods: Pre-and postoperative cephalometric analysis was performed on five patients who underwent superior impaction of the maxilla by Le Fort I osteotomy. The linear cephalometric measurements in the retropalatal region were done to examine changes in the posterior pharyngeal airway. Findings: The results show an advancement of 3 mm, 2.5 mm, 2 mm, 3 mm and 3 mm in the retropalatal region for a superior impaction of 5 mm, 5 mm, 4 mm, 5 mm and 5 mm in patients one, two, three, four and five respectively. The mean advancement was found to be 1 mm for every 1.6 mm superior impaction of the maxilla Conclusion: It is of the authors' opinion that superior repositioning of the maxilla results in predictable advancement of the maxilla and concurrently of the posterosuperior airway space.