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A Complication of Le Fort I Osteotomy
Le Fort I osteotomy (the surgical cutting of a bone, to allow realignment) is a routine procedure undertaken by oral and maxillofacial (affecting the jaws and face) surgeons. It is usually carried out safely as an elective procedure (surgery scheduled in advance because it does not involve a medical emergency) in hospitals with no complications. This report is about a case of Le Fort I osteotomy that resulted in an unusual complication in the form of cerebrospinal fluid (fluid held in and around the brain and spinal cord) leak.
A 19-year-old female was referred with an excessive exposure of the upper teeth and retrusive (located behind to the normal position) lower teeth. After the operation the patient was kept in hospital for monitoring. On the third day after the operation the patient complained about a persistent clear fluid discharging from the nose. On examination there was an obvious discharge of clear fluid from the left nostril. A sample of the fluid was collected and sent for laboratory analysis to discover what it was. The results showed that it was a cerebrospinal fluid (CSF) leak.
The leak did not resolve after 10 days. A lumbar drain (a small, flexible, soft plastic tube placed in the lower back to remove the spinal fluid) was placed to decrease the fluid pressure and allow the leak to hopefully stop. There was a reduction in the amount of leaking in the first 4 days but the leak did not stop and another lumbar drain was installed. On the sixth day following lumbar drain insertion, the leak stopped and the patient was discharged. On her follow-up visits she had made a complete recovery.
Le Fort I osteotomy is carried out safely in hospital settings on a daily basis. Surgical complications are relatively rare and usually include nerve damage or the misalignment of the teeth. Life-threatening complications are also although the operation is performed in an area with an extensive blood supply.