A modified Le Fort I osteotomy for maxillofacial deformity: a preliminary report.

A new technique of Le Fort I osteotomy using a wedge-shaped bony incision is described. After forward mobilisation of the osteotomised maxilla, the bone graft is held firmly in contact under some compression between the maxilla and the mobilised wedged portion to achieve greater stability. This is a very effective technique for those maxillary osteotomies which need bone graft stabilisation, such as in cleft lip and palate patients.     

Nasopharyngeal angiofibroma. surgical approach using a transoral Le Fort I osteotomy following embolization: a case report

Nasopharyngeal angiofibroma (NA) is a rare vascular benign nonencapsulated neoplasm, characterized by local aggressiveness and destructive potential, typically diagnosed in adolescent males. We report a case of NA affecting a 15-year-old male that presented with a persistent nasal obstruction and epistaxis with 1 year of evolution. Clinical and radiological patterns pointed out a differential diagnosis of NA. Arteriography demonstrates the vascular support of the tumor and evinces the embolization of the internal maxillary artery. The surgical approach was procedure by Le Fort I osteotomy exposing the tumor and promoting easy access for posterior removal. The surgery was carried out without hemorrhagic problems. The maxilla was fixed in the original position with 4 L-shape plaques. Histopathological findings supported the diagnosis of NA. The patient presented after 8 months of postoperative follow-up, without clinical signs of recurrence or residual tumor and without palatal or maxillary teeth paresthesia.     

A simple technique to facilitate the Le Fort I osteotomy downfracture.

In order to mobilize and reposition the maxilla when treating dentofacial deformities, the Le Fort I maxillary osteotomy is commonly used. Like other surgical procedures, this procedure is not without inherent difficulties. At times, it may be difficult to initially mobilize the maxilla after performing the osteotomies. Techniques used to help in the initial mobilization and downfracture of the maxilla from the pterygoid plates include digital pressure to the dentoalveolus, disimpaction forceps, spreaders, and other instruments. These techniques are similar in that they all apply a unidirectional downward vector of force on the maxilla and have various drawbacks. We present a technique that uses a 0.5-mm stainless steel traction wire to facilitate Le Fort I maxillary downfracturing by applying a forward and downward vector of force simultaneously. After vertical downfracture of the maxilla, lateral traction on the wire can be used to complete the pterygomaxillary disjunction. This technique has several advantages and is atraumatic, and requires no special instrumentation; thus, downfracturing of the maxilla is done with relatively little effort and minimal risk.     

Modified Le Fort I osteotomy with preservation of the anterior nasal spine position: preliminary report.

We present a modification of the traditional Le Fort I osteotomy by means of which the anterior nasal spine is left intact. The osteotomies advance from the posterior-lateral side of the maxillary bone through the tuberosity to the inferior-lateral wall of the piriform opening. Two other vertical osteotomies from the lateral side of the piriform opening are placed in a 90 degree fashion to connect with another horizontal osteotomy that runs 5 mm below the floor of the nasal cavity and the anterior nasal spine. In a series of 50 patients with Le Fort I osteotomies, we have performed this new technique in 5 patients. We have observed better esthetic results in terms of nasal tip position and a more predictable value for the nasolabial angle. We believe that this technique is more appropriate for larger advancements in which a large gap may occur at the end of the movement.     

A trifungal infection of the mandible: case report and literature review.

Orofacial fungal infections are occasionally seen in the immunocompromised patient. In this case, a patient with a relapse of an acute lymphoblastic leukemia (ALL) developed a fatal mandibular infection. This may be the first reported case of a trifungal infection with zygomycosis, aspergillosis, and candidiasis in the oral cavity and the fifth mandibular zygomycosis case. Epidemiology, diagnosis, treatment and prognosis of zygomycosis infection are reviewed, along with the 4 mandibular zygomycosis cases found in the English literature.     

The difficult Le Fort I osteotomy and downfracture: a review with consideration given to an atypical maxillary morphology.

SUMMARY: The Le Fort I osteotomy of the maxilla continues to be one of the most common techniques used in the surgical correction of a variety of dento-midfacial deformities. The procedure is generally considered to be operatively safe and postoperatively stable. Occasionally, however, surgeons may encounter difficulties during horizontal sectioning of the jaw, pterygomaxillary separation and or downfracture. In such cases, the steps leading up to and including the undertaking of a 'difficult' downfracture may put the patient at an increased risk of developing complications. The preoperative identification of potentially difficult cases, and in particular where evidence is suggestive of an atypical maxillary morphology, is extremely important in order to prevent or minimise the likelihood of a complication. In outlining some examples of such cases, we highlight the need to consider more exhaustive preoperative imaging of the maxilla and proffer some specific operative steps that can be employed to facilitate downfracture.     

Blindness and basal ganglia hypoxia as a complication of Le Fort I osteotomy attributable to hypoplasia of the internal carotid artery: a case report.

Le Fort I osteotomy is used as a surgical procedure for correction of maxillofacial deformities. The common complications of this procedure are hemorrhage and infection, with incidence of 6% to 9%. Blindness associated with Le Fort I osteotomy was reported in 8 patients. An 18-year-old female complained of loss of sight in the left eye after recovery from hypotensive general anesthesia. The visual field of the left eye was dark and only perceived some movement. She presented with motor dysfunction and regressive behavior 2 weeks later as a result of hypoxia of bilateral basal ganglia. Two months later, her visual acuity recovered gradually and regressive behavior improved. Carotid angiography showed congenital hypoplasia of the left internal carotid artery. We suspected that hypoplasia could cause hypoxia of the central nervous system.     

Acute pancreatitis secondary to dehydration: case report and review of the literature.

Recent reports have documented the potentially catastrophic consequences of dehydration induced by vigorous exercise in otherwise healthy individuals. A case of acute pancreatitis secondary to exercise-induced dehydration is presented, and the literature of dehydration-induced syndromes, both research and clinical, is reviewed. The goal of this case report is to heighten awareness of dehydration as a potential cause of acute pancreatitis.     

A report of 2 patients with transient blindness following Le Fort I osteotomy and a review of past reported cases

Blindness following a LeFort I osteotomy is a rare but extremely serious complication. Ten cases have been reported to date. None of these patients recovered vision. Optic neuropathy is believed to be the cause but the exact mechanism has not been settled. We report the first, and the only two, documented cases of complete loss of vision that recovered subsequently. The first patient was a 19-year-old male with repaired bilateral cleft lip and palate. He developed loss of vision in the right eye on the second postoperative day. The second patient was a 22-year-old male with repaired unilateral cleft lip and palate. He developed complete loss of vision in the left eye on the day of surgery. Both these patients underwent ongoing studies, which did not show any abnormalities. Both were treated with methylprednisolone. Both the patients gradually showed improvement in their vision. The first patient recovered normal vision several months postoperatively. The second patient''s vision improved to 4/60 by 4 months postoperatively. We discuss the probable mechanisms of optic nerve injury and also the possible reasons why sight was restored in these patients. This is a rare but serious complication following a fairly common procedure. Through this article we wish to create an awareness of this complication and also a possible way of avoiding such a disaster.KEY WORDS: Blindness, complications, hypotensive anaesthesia, LeFort I osteotomy, maxillary regression     

Symptomatic pineal cyst: case report and review of the literature

Asymptomatic cysts of the pineal region are common incidental findings in adults. In contrast, symptomatic pineal cysts are rare and their management is not well defined. We present the case of a 39-year-old woman suffering from intracranial hypertension, with visual disturbance and mild papilledema. The MR images showed a voluminous cyst of the pineal region responsible for an obstructive hydrocephalus. Endoscopic treatment with the aid of computerized neuronavigation consisting in third ventriculostomy and fenestration of the cyst was performed. Intracranial hypertension symptoms resolved in 24 hours. The one year follow-up cerebral MR images demonstrated the normalization of ventricular size with patency of the aqueduct of Sylvius. Reviewing the literature demonstrates that the endoscopic approach represents a minimally invasive and safe procedure in the treatment of symptomatic pineal cysts.     

Hemorrhagic colloid cyst: case report and review of the literature

Colloid cysts are benign tumors situated in and connected to the roof of the third ventricle. The clinical presentation is diverse, varying from incidentally found cysts to acute death. This presentation is explained by an acute hydrocephalus due to an obstruction of the cerebrospinal fluid (CSF) flow at the level of the foramina of Monro. Why these lesions cause a sudden obstruction is not clear in most cases. Possible explanations of a sudden deterioration are shifts of the cysts after lumbar puncture or CSF flow obstruction after shunt dysfunction. We add an explanation for the acute deterioration of patients with colloid cysts (ie, hemorrhagic changes in the cysts). This complication has been published only 4 times before, all diagnosed at postmortem examination. A young patient is presented with a recently diagnosed and symptomatic colloid cyst who deteriorated the night before surgery because of intracystic hemorrhage. Despite emergent CSF diversion, our patient remained in a poor clinical condition. We review the literature about this topic and discuss the consequences for the neurosurgical practice.     

Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection:A case report and review of the literature

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.     

Condylar and disc positions after sagittal split ramus osteotomy with and without Le Fort I osteotomy.

PURPOSE: The purpose of this study is to examine the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) with and without a Le Fort I osteotomy. SUBJECTS AND METHODS: Of 45 Japanese patients with mandibular prognathism, 23 underwent SSRO and 22 underwent SSRO in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including disc tissue, were assessed preoperatively and postoperatively by magnetic resonance imaging (MRI) and axial cephalography. RESULTS: There were significant differences between pre- and postoperative horizontal changes in the condylar long axis on the right side in the group undergoing SSRO (sagittal split ramus osteotomy) alone. However, there were no other significant differences in pre- and postoperative measurements in this group as compared with the group receiving SSRO plus Le Fort I osteotomy, and the preoperative disc position could not be changed in either group. CONCLUSION: These results suggest that SSRO, either with or without Le Fort I osteotomy, could not change the preoperative disc position or correct anterior disc displacement, although these procedures did improve the symptoms associated with TMJ dysfunction.     

Large gastric mesenteric cyst: case report and literature review

The case is a 33-year-old white female presenting with a 3-day history of abdominal pain. On initial examination, she was found to have significant right lower quadrant tenderness. Workup included computed tomography, which demonstrated a large cystic mass appearing to be of ovarian origin. The patient required an exploratory laparotomy, at which time she was found to have a large cyst involving the lesser curvature of her stomach. The cyst was successfully resected, and the patient had a rapid postoperative recovery with complete resolution of symptoms. Histopathologic evaluation of the specimen identified a mesenteric cyst. Mesenteric cysts are uncommon; gastric involvement is exceedingly rare. A review of the literature is presented.