J Korean Assoc Oral Maxillofac Surg 2019; 45(6): 364~368
An idiopathic delayed maxillary hemorrhage after orthognathic surgery with Le Fort I osteotomy: a case report
Byungho Park, Wan-Hee Jang, Bu-Kyu Lee
Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Bu-Kyu Lee
Department of Oral and Maxillofacial Surgery, Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
TEL: +82-2-3010-5907 FAX: +82-2-2045-4068
E-mail: bukyu.lee@gmail.com
ORCID: https://orcid.org/0000-0001-8888-1719
Received November 5, 2019; Revised November 14, 2019; Accepted November 18, 2019.; Published online December 31, 2019.
© The Korean Association of Oral and Maxillofacial Surgeons.. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A Le Fort I osteotomy is a common procedure for correcting dental and facial deformities in orthognathic surgery. In rare cases, a delayed hemorrhage can occur as early as several hours or up to 12 weeks, postoperatively. The most frequently involved blood vessels in a delayed hemorrhage are the descending palatine artery, the internal maxillary artery, and the pterygoid venous plexus of veins. Intraoral bleeding accompanied by severe epistaxis in these cases makes it difficult to locate the precise bleeding focus. Eventual uncontrolled bleeding would require Merocel packing or surgical intervention. In general, a severe late postoperative hemorrhage is most effectively managed by angiography and embolization. Herein we describe a delayed hemorrhage case in which the cause was not evident on angiography. We were able to detect the bleeding point through an endoscopic nasal approach and treat it using direct cauterization.
Keywords: Epistaxis, Postoperative complication, Le Fort I osteotomy, Pseudoaneurysm

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31 December 2019
Vol. 45
No. 6 pp. 301~378

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