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An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report

대한구강악안면외과학회지 2019년 45권 6호 p.364 ~ 368
박병호 ( Park Byung-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery

장완희 ( Jang Wan-Hee ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery
이부규 ( Lee Bu-Kyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Oral and Maxillofacial Surgery

Abstract


A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.

키워드

Epistaxis; Postoperative complication; Le Fort I osteotomy; Pseudoaneurysm
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