Intra- and perioperative complications of the LeFort I osteotomy: A prospective evaluation of 1000 patients
Intra- and perioperative complications of the LeFort I osteotomy: A prospective evaluation of 1000 patients
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DOI：
10.1097/00001665-200411000-00016
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发表时间：
2004-11-01
影响因子：
0.9
通讯作者：
Brachvogel, P
中科院分区：
文献类型：
--
作者：
Kramer, FJ;Baethge, C;Brachvogel, P
LeFort I 截骨术已成为择期正颌手术的常规手术。作者报告了在 20 年内进行的一系列 1000 次连续 LeFort I 截骨术中发生的术中或围手术期并发症。总共有 64 名 (6.4%) 患者出现并发症。解剖并发症影响了 26 名患者（2.6%），其中 16 名患者（1.6%）患有鼻中隔偏曲，10 名患者（1.0%）患有截骨间隙不愈合。 11 名（1.1%）患者仅在双颌矫正后出现大面积出血，需要输血；一名患者需要结扎外颈动脉。 11 名（1.1%）患者出现脓肿或上颌窦炎等严重感染。没有患者出现骨髓炎。缺血性并发症影响了 10 名患者 (1.0%)，其中 2 名患者 (0.2%) 经历了牙槽突无菌性坏死，8 名患者 (0.8%) 在进行紧急翻修时受到牙龈退缩的影响。五名 (0.5%) 患者经历了接骨材料固定不充分的情况。解剖结构不规则的患者（例如，颅面发育不良、口面裂或血管异常的患者）并发症的风险和程度增加。上颌骨广泛脱位或横向分割会增加缺血性并发症的风险。作者得出的结论是，应告知患有严重解剖不规则的患者 LeFort I 截骨术的风险增加。术前计划避免上颌骨横向分割或广泛脱位，应减少并发症的发生。对于健康个体来说，LeFort I 截骨术出现并发症的风险较低。
The LeFort I osteotomy has become a routine procedure in elective orthognathic surgery. The authors report the occurrence of intra- or perioperative complications in a series of 1000 consecutive LeFort I osteotomies performed within a 20-year period. In total, 64 (6.4%) patients experienced complications. Anatomical complications affected 26 (2.6%), patients, including 16 (1.6%) with a deviation of the nasal septum and 10 (1.0%) with nonunion of the osteotomy gap. Extensive bleeding that required blood transfusion occurred in 11 (1.1%) patients exclusively after bimaxillary corrections; in 1 patient a ligation of the external carotid artery became necessary. Significant infections such as abscesses or maxillary sinusitis occurred in 11 (1.1%) patients. No patient experienced an osteomyelitis. Ischemic complications affected 10 (1.0%) patients, including 2 (0.2%) who experienced an aseptic necrosis of the alveolar process and 8 (0.8%) who, under critical revision, were affected by retractions of the gingiva. Five (0.5%) patients experienced an insufficient fixation of the osteosynthesis material. The risk and the extent of complications was enhanced in patients with anatomical irregularities (eg, in patients with craniofacial dysplasias, orofacial clefts, or vascular anomalies). The risk of ischemic complications was enhanced in extensive dislocations or transversal segmentation of the maxilla. The authors conclude that patients with major anatomical irregularities should be informed about an enhanced risk of LeFort I osteotomies. Preoperative planning avoiding transversal segmentation or extensive dislocations of the maxilla should reduce the occurrence of complications. For healthy individuals, the risk of complications with the LeFort I osteotomy is considered low.