An arteriovenous fistula of the maxillary artery as a complication of Le Fort I osteotomy

Summary 

Introduction

The Le Fort I osteotomy, one of the most common techniques used to correct dento-midfacial deformities, is generally considered to be operatively safe. However, sometimes this procedure can lead to fatal vascular complications.

Materials and methods

This article describes a fifty-year-old woman with a giant facial venous malformation. The patient underwent a Le Fort I osteotomy in order to correct an open bite. The surgery was complicated by the development of an arteriovenous fistula (AVF) between the maxillary artery and the venous malformation, the diagnosis of which was made by ultrasound doppler. Neuroradiological embolisation process of the maxillary artery was performed in order to close the AVF.

Results

The total fistula obliteration and a Class I occlusion were obtained.

Conclusions

The reported case suggests the necessity of a multidisciplinary process (involving both maxillofacial and neuroradiology teams) for the treatment of dento-midfacial deformities in relation to vascular malformations. This modality is the only way to guarantee minimization of morbidity (according to patient's expectations).

Keywords: open bite, facial venous malformation, Le Fort I osteotomy, arteriovenous fistula, complication, embolisation