Case Report: Delayed onset of severe acute facial swelling following bimaxillary osteotomy surgery

Abstract

This case report will discuss a 20-year-old male who presented to the Accident and Emergency (A&E) department at a district general hospital (DGH) with severe bilateral submandibular facial swelling four days following bimaxillary osteotomy surgery to correct his mandibular prognathism and maxillary retrognathism.The patient had previously undergone both bilateral sagittal split (BSSO) and LeFort 1 osteotomy surgery for the correction of a severe class 3 skeletal discrepancy following orthodontic treatment. The osteotomy was stabilised with titanium fixation plates. Following the surgical treatment, the patient received a regime of co-amoxiclav antibiotic prophylaxis and dexamethasone to combat post-operative inflammation. After an uneventful surgery and a single night in hospital post-operative inpatient stay, the patient was discharged with oral antibiotics and chlorhexidine mouth rinse along with their regular inhalers for his medical history including mild well controlled asthma.Four days following the surgery, the patient presented to A&E complaining of sudden onset severe dysphagia, trismus, and bilateral submandibular and submental facial swelling, only noticed on waking. This case report will discuss the indications of a bimaxillary osteotomy as well as the management and treatment of post-operative complications following this surgery.