Kramer Franz-Josef, Baethge Carola, Swennen Gwen, Teltzrow Thomas, Schulze Andrea, Berten Johannes, Brachvogel Peter
Departments of Oral and Maxillofacial Surgery, Medical University of Hannover, Hannover, Germany.
J Craniofac Surg. 2004 Nov;15(6):971-7; discussion 978-9. doi: 10.1097/00001665-200411000-00016.
The LeFort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra- or perioperative complications in a series of 1000 consecutive LeFort I osteotomies performed within a 20-year period. In total, 64 (6.4%) patients experienced complications. Anatomical complications affected 26 (2.6%), patients, including 16 (1.6%) with a deviation of the nasal septum and 10 (1.0%) with non-union of the osteotomy gap. Extensive bleeding that required blood transfusion occurred in 11 (1.1%) patients exclusively after bimaxillary corrections; in 1 patient a ligation of the external carotid artery became necessary. Significant infections such as abscesses or maxillary sinusitis occurred in 11 (1.1%) patients. No patient experienced an osteomyelitis. Ischemic complications affected 10 (1.0%) patients, including 2 (0.2%) who experienced an aseptic necrosis of the alveolar process and 8 (0.8%) who, under critical revision, were affected by retractions of the gingiva. Five (0.5%) patients experienced an insufficient fixation of the osteosynthesis material. The risk and the extent of complications was enhanced in patients with anatomical irregularities (eg, in patients with craniofacial dysplasias, orofacial clefts, or vascular anomalies). The risk of ischemic complications was enhanced in extensive dislocations or transversal segmentation of the maxilla. The authors conclude that patients with major anatomical irregularities should be informed about an enhanced risk of Le-Fort I osteotomies. Preoperative planning avoiding transversal segmentation or extensive dislocations of the maxilla should reduce the occurrence of complications. For healthy individuals, the risk of complications with the LeFort I osteotomy is considered low.
勒福 I 型截骨术已成为择期正颌外科手术中的常规操作。作者报告了在20年期间连续进行的1000例勒福 I 型截骨术中术中和围手术期并发症的发生情况。总共有64例（6.4%）患者出现并发症。解剖学并发症影响了26例（2.6%）患者，包括16例（1.6%）鼻中隔偏曲和10例（1.0%）截骨间隙不愈合。仅在双颌矫正后，11例（1.1%）患者出现需要输血的大量出血；1例患者需要结扎颈外动脉。11例（1.1%）患者发生了如脓肿或上颌窦炎等严重感染。没有患者发生骨髓炎。缺血性并发症影响了10例（1.0%）患者，包括2例（0.2%）发生牙槽突无菌性坏死，8例（0.8%）在严格检查时出现牙龈退缩。5例（0.5%）患者出现骨合成材料固定不充分。解剖结构异常的患者（如颅面发育不全、口腔颌面部裂隙或血管异常患者）并发症的风险和程度会增加。上颌骨广泛脱位或横向分割时缺血性并发症的风险会增加。作者得出结论，应告知存在主要解剖结构异常的患者勒福 I 型截骨术风险增加。术前规划避免上颌骨横向分割或广泛脱位应能减少并发症的发生。对于健康个体，勒福 I 型截骨术的并发症风险被认为较低。
