Blindness as a complication of high Le Fort I

[marcolob]

SERIOUS FOOD FOR THOUGHT people: "In conclusion, a total of seven cases [out of 94] developed blindness after [high] Le Fort I osteotomy. Once blindness develops, the prognosis is poor. High Le Fort I osteotomy should be performed with extreme care, and perhaps the informed consent should include visual loss as a complication of the procedure." link here http://europepmc.org/abstract/MED/11818854/reload=0;jsessionid=dBLVNZpx2nr9pnUMnOop.8

so i'm now rethinking whether HA paste is a better tradeoff for its better safety.

[Cmonster]

Yikes.... Its definitely a possibility, it is surgery. Hi-leforts arent as common at least not on the boards but it really depends on the skill of the surgeon.

[Alue]

I came across this before, I was considering High lefort 1 (well I still am just not at this moment).  I asked about the possibility of blindness and my surgeon didn't say it was a risk.  I'd like to see more sources on the topic.  The fact that they could not find any signs of orbital injury, vascular problem, or abnormal fractures seems odd to me.  I would think, if anything, it would be from a vascular injury. 

[PloskoPlus]

I think those were paediatric syndrome cases. Cleft lip, etc.. Don't think they apply to adults.

EDIT:
Looking over my notes... My surgeon did mention cutting higher to fill out the midface more.  I asked him if it was a High Le Fort I, but he said that I don't need it, since my face is wide enough and I'm not a syndrome case.  It'll be higher than normal, but still a normal Le Fort I.  I dunno, I think my upper midface is lacking.  Maybe HA paste is the answer.

[earl25]

I dont know. I've been  consulting with top maxfaxs about a modified lefort III oesteotomy (moving just the mid face not the nose or the teeth portion of maxilla). I asked them all about blindness and they pretty much shrugged it off and said very low risk because the optic nerve is nowhere near the incision area.  All said its no more of a blindness risk then implants or even fat graph or a bleph. I dont know how much I beleive that. im scared of an embelism in the eye area, that will knock out your vision.

[PloskoPlus]

I dont know. I've been  consulting with top maxfaxs about a modified lefort III oesteotomy (moving just the mid face not the nose or the teeth portion of maxilla). I asked them all about blindness and they pretty much shrugged it off and said very low risk because the optic nerve is nowhere near the incision area.  All said its no more of a blindness risk then implants or even fat graph or a bleph. I dont know how much I beleive that. im scared of an embelism in the eye area, that will knock out your vision.

Who's willing to do it?

[earl25]

Who's willing to do it?

I saw schendel,wolford, sinn,turvey, obwegeser,keller all do a modified version . they don't move the nose.

[Alue]

I saw schendel,wolford, sinn,turvey, obwegeser,keller all do a modified version . they don't move the nose.

What's the modification they do?  Lefort 1 should never move the nose (although it can change nose shape).

[toothfairy]

I had double jaw surgery and lost some of my vision although it was probably due to the anesthetic. My surgeon shrugged it off as being due to my age, however the day before the surgery I could see perfectly and didn't need glasses. The second day after the surgery I went to use my laptop and the screen was all blurry. It has been like this ever since (six months since surgery) and I now need glasses to see my screen. Studies do show that some people (25%) lose some vision after a long anesthetic.

[earl25]

I had double jaw surgery and lost some of my vision although it was probably due to the anesthetic. My surgeon shrugged it off as being due to my age, however the day before the surgery I could see perfectly and didn't need glasses. The second day after the surgery I went to use my laptop and the screen was all blurry. It has been like this ever since (six months since surgery) and I now need glasses to see my screen. Studies do show that some people (25%) lose some vision after a long anesthetic.

how long was your surgery?

[DrBirbe]

It would be a good idea to have a CT scan of your cranial base to rule out a fracture line as a consequence of a bad split of the lefort I at the pterigomaxillary junction. If this is negative, the differential diagnosis would be between a vascular accident involving the oftalmic vessels or as you mention a consequence of the anesthesia.

[toothfairy]

My surgery was 6.5 hours long.

[toothfairy]

DrBirbe,
Would the fact that I'm not blind and my vision hasn't deteriorated since the surgery (6 months ago), allow me to assume that I'm Ok and won't need a CT scan  or should I ask my surgeon  for a CT scan anyway. I don't want to sound like an alarmist if the danger is over.

Thanks DrBirbe for your advice