Craniofacial Surgery Results in Severe Facial Nerve Damage


This case involves a thirty-three-year-old female who underwent a Le Fort osteotomy with a differential impaction and bilateral sagittal split osteotomy. The preoperative diagnosis was dentofacial deformity with vertical maxillary access, mandibular asymmetry, and maxillary asymmetry.  Postoperatively, the patient suffered from extreme pressure in the nose, throat, and eyes that went untreated for several months. The patient was advised by a subsequent, treating oral surgeon that this was the result of surgical screws and a fixation plate that were placed too high into the eye sockets. As a result, the patient required two additional surgeries and still suffers from persistent facial numbness due to nerve damage.

Question(s) For Expert Witness

  • 1. Are you familiar with this procedure and its complications?

Expert Witness Response E-005968

I am very familiar with the Le Fort Osteotomy, as it has become a routine procedure in elective orthognathic surgery. Recent studies have demonstrated the complications that may arise from this procedure. Anatomical complications have occurred, including patients with a deviation of the nasal septum and with non-union of the osteotomy gap. Also, some patients experienced extensive bleeding that required blood transfusions, but this was usually after bimaxillary corrections. Occasional infections such as abscesses or maxillary sinusitis occurred on a less frequent basis. Additionally, certain patients experienced ischemic complications.

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