Life-threatening hemorrhage from a Le Fort I osteotomy

Abstract

On July 29, 1980, a healthy 32-year-old white woman was admitted to the Oral and Maxillofacial Surgery Service of another hospital for correction of vertical maxillary excess and mandibular retrognathia. This was to be accomplished via Le Fort I osteotomy and mandibular autorotation. The review of systems, past medical history, and past surgical history was noncontributory. Physical examination was significant for vertical maxillary excess, increased lower facial height, mandibular retrognathia, and lip incompetence. The remainder of her examination was unremarkable. On July 30, 1980, the patient was taken to the operating room, where. under general nasoendotracheal anesthesia. a Le Fort I osteotomy was accomplished by incorporating a bilateral 8 mm ostectomy posteriorly and a bilateral 6 mm ostectomy anteriorly. The osteotomies were made with a reciprocating saw. The lateral nasal walls and nasal septum were sectioned with a forked nasal gouge and the bilateral pterygomaxillary dysjunction was effected with a curved osteotome. No significant bleeding was encountered to this time. Manipulation of the maxilla into a down-fractured position was attended with profuse arterial hemorrhage from the right posterior region. Attempts to visualize the source of the bleeding were unsuccessful. Immediate measures to stabilize the patient included multiple arterial and venous cutdowns, infusion of 15 units of packed erythrocytes, two units of autologous whole blood, four units of plasmanate, and four units of fresh frozen plasma. The right external carotid artery was