Laser-Assisted Indocyanine Green Imaging for Assessment of Perioperative Maxillary Perfusion During Le Fort I Osteotomy: A Pilot Study

Abstract

To determine the changes in maxillary perfusion during different stages of Le Fort I osteotomies as measured by laser-assisted indocyanine green imaging (LAICGI) and to determine whether various clinical factors affect maxillary vascular perfusion. The medical records of those who had undergone Le Fort I osteotomy with LAICGI at the University of Illinois from 2016 to 2017 were reviewed retrospectively. The maxillary perfusion levels using LAICGI were measured before induction, after induction, after down fracture, after segmentalization (for segmental osteotomies), and after wound closure. The effects of clinical variables, including gender, race, American Society of Anesthesiologists physical status, type of Le Fort I osteotomy, intraoperative status of the descending palatine vessels, maxillary movements (anteroposterior, vertical, transverse), and hemodynamic data (mean arterial blood pressure, heart rate), were analyzed. Compared with the preoperative baseline values, the indocyanine green (ICG) levels decreased after down fracture and mobilization, segmentalization, and wound closure; no statistically significant differences were found among these 3 points. Segmentalization did not affect the ICG levels compared with the nonsegmentalized cases. Male gender and the amount of maxillary impaction were significantly associated statistically with decreased ICG levels, although the difference was not clinically significant. Compared with the baseline levels, maxillary perfusion, as measured by LAICGI, decreased from down fracture to wound closure. Segmentalization did not appear to influence maxillary perfusion, although male gender and impaction were associated with decreased perfusion. Because of its safety and convenience, LAICGI shows promise as a method of assessing maxillary perfusion in future largescale prospective studies linking perioperative perfusion to the occurrence of aseptic necrosis.