Changes in maxillary perfusion following Le Fort Iosteotomy in orthognathic surgery

Abstract

Le Fort I osteotomy is a surgical procedure that can be used in adaptation of abnormally positioned jaws, skeletal malocclusions,aesthetic operations, treatment of obstructive sleep apnea, access to tumors with intracranial extensions and in other types of skullbase surgery. The main problems in Le Fort I osteotomy which is performed using various techniques directed to the maxilla areintraoperative bleeding and impaired blood supply of the osteotomized segment. Results of studies evaluating the perfusion of themaxilla during and after Le Fort I osteotomy were reviewed in the present study.Vascular events occurring during surgery should be better acknowledged in order to prevent complications such as intraoperativeinsufficient maxillary perfusion or postoperative bleeding. Maxillary perfusion after maxillary downfracture depends on palatal andposterior buccal soft tissue pedicles. The conclusions from previous extensive studies on maxillary blood supply after downfracturehave shown that a properly performed single-segment Le Fort I osteotomy is predictable and safe. However, factors such asmultisegmentalization of the maxilla, traction of the pedicle as a result of significant dentoosseous reposition, routine ligation ortraction of descending palatine artery, hypotensive anesthesia, transverse laceration in the palatal soft tissues, compression, andpre-existing scar tissue adversely affect the blood flow from these pedicles to the maxillary hard and soft tissues. As a result, it can be suggested that complications related to intraoperative and postoperative perfusion of maxilla in Le Fort Iosteotomy are rare and this surgery is safe.