Complications following Le Fort osteotomy are relatively rare compared to the number of procedures performed. Fortunately, most of them are not severe. In a study conducted by Politis, on 750 Le Fort I osteotomies, only two cases of life-threatening bleeding have been reported. However, as the author pointed out, such complications could be underestimated, since patients experiencing massive nasal bleeding will not be treated necessarily in the same hospital or by the same surgeon.
During Le Fort I osteotomies and more precisely at the moment of pterygomaxillary separation, damage to the internal maxillary artery or one of its branches, may occur. Bendrihem and Vacher performed a tomodensitometric study to measure the position of maxillary artery in relation to pterygomaxillary junction. They concluded that there is a risk of injuring the maxillary artery 18 mm above the inferior extremity of the pterygomaxillary junction. It is to say how much we are close when performing pterygomaxillary separation. In general, damage to vessels causes an acute bleeding which can be controlled intraoperatively. But, in other situations, where the vessels are partially injured, a weak point on the vessel wall can lead to the formation of a pseudoaneuvrysm which may result in a delayed post-operative bleeding when it ruptures. For our patient and for most of the patients with this condition, bleeding occurs within the first 14 days post-operatively. Elsewhere, longer delays up to 3 months post-operatively have been reported. The diagnosis of pseudoaneuvrysm is strongly suggested by patients’ history. Angiography confirm the diagnosis, locate precisely the site of bleeding and treat on the same occasion if necessarily. In the management of this case, it was elected not to perform an embolization because adequate haemostasis was achieved with anterior and posterior nasal packing.