Department of Oral and Maxillofacial Surgery, Faculty of medicine, University of Tours, France.
J Craniomaxillofac Surg. 2010 Jun;38(4):251-4. doi: 10.1016/j.jcms.2009.07.002. Epub 2009 Aug 3.
The Le Fort I osteotomy, one of the most common techniques used to correct dento-midfacial deformities, is generally considered to be operatively safe. However, sometimes this procedure can lead to fatal vascular complications.
This article describes a fifty-year-old woman with a giant facial venous malformation. The patient underwent a Le Fort I osteotomy in order to correct an open bite. The surgery was complicated by the development of an arteriovenous fistula (AVF) between the maxillary artery and the venous malformation, the diagnosis of which was made by ultrasound doppler. Neuroradiological embolisation process of the maxillary artery was performed in order to close the AVF.
The total fistula obliteration and a Class I occlusion were obtained.
The reported case suggests the necessity of a multidisciplinary process (involving both maxillofacial and neuroradiology teams) for the treatment of dento-midfacial deformities in relation to vascular malformations. This modality is the only way to guarantee minimization of morbidity (according to patient's expectations).
Le Fort I 截骨术是矫正牙颌面畸形最常用的技术之一，通常被认为是手术安全的。然而，有时该手术会导致致命的血管并发症。
本文描述了一位五十岁的女性，患有巨大面部静脉畸形。患者接受 Le Fort I 截骨术以矫正开咬。手术过程中出现上颌动脉与静脉畸形之间的动静脉瘘（AVF），通过超声多普勒诊断。为了闭合 AVF，对颌内动脉进行了神经放射栓塞治疗。
完全闭塞瘘管并获得 I 类咬合。
该病例提示需要多学科治疗（涉及颌面外科和神经放射科团队）来治疗与血管畸形相关的牙颌面畸形。这种方法是保证最小化发病率（根据患者的期望）的唯一途径。
