A 39-year-old woman was admitted for surgical treatment of dentofacial deformity.
Her personal history included iron deficiency anemia without any known drug allergy.
Physical examination revealed prognathism with a class III molar and pseudohypoplasia of the upper jaw.
The patient underwent an orthopantomography and teleradiography lateral skull, starting the corresponding cephalometric study.
After orthodontic treatment and extraction of the 4 chordae, the patient underwent conventional orthognathic surgery septum under general anesthesia and nasotracheal intubation upper jaw impact plates septum I fixed maxillary osteotomy Left lip.
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The patient was discharged and followed up in outpatient consultations with recurrent episodes of bilateral genial arthritis.
Its onset occurred 6-9 months after the initial intervention.
It was decided to reoperate the patient one year after the first intervention and remove the osteosyntesis material at the level of the osteotomy LeFort I after reopening the previous bilateral superior sublabial approach.
Intraoperatively there is no mobility of the middle third of the face at the level of the osteotomy type LeFort I and this surgical episode is catalogued as an intolerance to the osteosyntesis material.
After following regular follow-up visits, both in our outpatient clinics and with the orthodontist, one year after the last surgery, the patient reported a decrease in strength with chewing, preventing solid foods.
The clinical examination showed mild mobility of the upper jaw at the level of LeFort I, maintaining the patient a correct occlusion in class I. The CT of the middle facial third requested showed absence of consolidation in the upper jawbone Given the solution
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It was decided to reoperate the patient for the definitive management of this complication.
After performing class I elastic intermaxillary block and reopening the previous upper sublabial approach, the fibrous tissue interposed in the bony margins at the level of the maxillary osteotomy is removed.
Maxillary osteotomy was fixed using two preformed titanium plates with the initially established advance.
Spongy bone grafts are obtained from the right tibia through a medial approach and placed in the bone gap of the Le-Fort I osteotomy sealing this defect.
The anatomopathological study of the tissue located in the interfractureal focus reveals the presence of cartilaginous cells within a tissue with predominantly fibrotic proliferation.
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After this intervention it is followed in our consultations appraising the consolidation at the level of the osteotomy, without mobility of it, with a stable occlusion and favorable aesthetic appearance.
No complications were observed after tibial graft harvest, and the control X-ray was favorable.
