A case of maxillary partial aseptic necrosis after Le Fort I osteotomy

Abstract

While orthognathic surgery is now a safe and established procedure, it poses associated complications, similarly to every surgical procedure. Aseptic necrosis is an ischemic complication associated with orthognathic surgery. Although aseptic necrosis is a serious complication, treatment protocol has not yet been established. Herein we reported a case of aseptic necrosis occurring in the maxilla following Le Fort I (LFI) osteotomy. The patient was a 25-year-old woman referred to our hospital with a chief complaint of maxillary alveolar bone exposure. She had been submitted to horseshoe-type LFI osteotomy and bilateral sagittal split ramus osteotomy two months earlier. At initial visit, osseous non-union of the maxilla and exposure of the right anterior maxillary alveolar bone were observed. At first surgery, necrotic alveolar bone and soft tissue were debrided, titanium plates were removed, and a new titanium plate was provided for adequate osteosynthesis in left-side bone gap under general anesthesia. At second surgery, 11.12.13.14 were extracted and alveolus was reconstructed by iliac crest graft. In addition, 21 was extracted under local anesthesia owing to tooth mobility, and root canal treatment to 22.23 was performed. After 6 months, the plates were removed, and four implants were placed. At third surgery, oral vestibular extension operation was performed. Five years following the initial procedure, the patient achieved normal occlusion and dentofacial appearance.