Inadvertent fracture of the base of the skull.Nonunion or malunion of the maxilla due to poor skeletal fixation, insufficient bony contact, or instability of bone fragments.Complications associated with prolonged hypotensive general anesthesia.Thrombosis of the internal carotid artery due to the excessive head and neck extension.Direct or indirect damage to major vessels in the neck or skull, including the internal carotid artery and internal jugular vein.Severe hemorrhage due to injury to the internal maxillary artery, the posterior superior alveolar artery, and the greater palatine artery.The surgical approach and postoperative management are similar to the Le Fort II procedure.īrow lift procedures may be carried out at the same time as Le Fort II and Le Fort III osteotomies.Īs with any surgical procedure, Le Fort osteotomies have their risks of complications. The Le Fort III Osteotomy is used to correct generalized growth failure of the midface involving the upper jaw nose and cheekbones (zygomas). The latter often requires transnasal canthopexy through the osteotomy gap so that the ligaments can be approximated and moved into a more posterior position. The former can be avoided by judicious bone removal in order to reduce the nasofrontal angle at osteotomy. Intranasally, a branch of the fracture extends through the base of the perpendicular plate of the ethmoid, through the vomer, and the interface of the pterygoid plates to the base of the sphenoid. Instead, the fracture continues along the floor of the orbit along the inferior orbital fissure and continues superolateral through the lateral orbital wall, through the zygomaticofrontal junction and the zygomatic arch. The thicker sphenoid bone posteriorly usually prevents the continuation of the fracture into the optic canal. These fractures start at the nasofrontal and front maxillary sutures and extend posteriorly along the medial wall of the orbit through the nasolacrimal groove and ethmoid bones. This is also termed craniofacial disjunctions, may follow impact to the nasal bridge or upper maxilla. Signs and symptoms are step deformity at the infraorbital margin, mobile mid-face, anesthesia or paresthesia of the cheek.
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