A case of mediastinal emphysema and pneumothorax developing after Le Fort I osteotomy and intraoral vertical ramus osteotomy

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  • MATSUMOTO Seibu
    Department of Oral and Maxillofacial Surgery, Uwajima City Hospital
  • FUJISAWA Toru
    Department of Oral and Maxillofacial Surgery, Uwajima City Hospital
  • KIRISAWA Tomoko
    Department of Oral and Maxillofacial Surgery, Uwajima City Hospital
  • MORIOKA Keiichi
    Department of Oral and Maxillofacial Surgery, Uwajima City Hospital
  • MORIYA Yoshiyuki
    Department of Oral and Maxillofacial Surgery, Uwajima City Hospital

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Other Title
  • Le Fort I型骨切り術および下顎枝垂直骨切り術術後に縦隔気腫および気胸を生じた1例
  • Le Fort Ⅰ カタ ホネキリ ジュツ オヨビ カガク シ スイチョク ホネキリ ジュツ ジュツゴ ニ ジュウカクキシュ オヨビ キキョウ オ ショウジタ 1レイ

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Abstract

We report a case of mediastinal emphysema and pneumothorax following intraoral vertical ramus and Le Fort I osteotomies. A 19-year-old man was presented at our hospital with anterior cross-bite. We diagnosed open bite, retromaxillism and skeletal class III malocclusion and, following preoperative orthodontics, he was admitted for surgery in March 2011. Intraoral vertical ramus and Le Fort I osteotomies were performed under general anesthesia. However, bilateral nasal obstruction and labored breathing appeared after the operation. Moreover, he felt something wrong in the precordium and neck on the day following the operation. He had difficulty in breathing and fine crackle was heard in the supraclavicular space and sternum region on postoperative day five. Lucencies were acknowledged by computed tomographic scanning in the right pterygomandibular space, both sides of the prestyloid and retrostyloid parapharyngeal space, retropharyngeal space, anterior tracheal wall, upper mediastinal space, and left thoracic cavity. The lower lobe of the left lung had shrunk. He was diagnosed with subcutaneous emphysema from the neck to the mediastinum, and left pneumothorax. His breathing normalized after removal of the surgical splint. Twelve days after onset a chest X-ray showed his mediastinal emphysema and pneumothorax had improved, and he was discharged on postoperative day 14.

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