Cerebrospinal Fluid Leak following LeFort I Osteotomies

Abstract

Objective: 1) Describe an unusual complication of cerebrospinal fluid leak (CSF) following orthognathic surgery through LeFort I osteotomies. 2) Understand the mechanism and incidence of injury and techniques of endoscopic repair. 3) Review the literature regarding skull base defects and CSF leaks following maxillofacial advancement. Method: Case report, single patient, 2012, literature review. Results: An 18 year-old morbidly obese woman presented to the oral maxillofacial surgery clinic with complaints of malocclusion. She underwent bilateral LeFort I osteotomies and was discharged on POD1. She represented 3 days later with headache and nausea. A head CT demonstrated pneumocephalus and a fracture of the dorsal aspect of the right sphenoid sinus causing a communication with the prepontine cistern. The patient subsequently underwent endoscopic repair by the otolaryngology and neurosurgery services, using a vascularized pedicled mucosal nasoseptal flap. She was discharged from the hospital on postoperative day 7 and since has had an uneventful recovery. Conclusion: Postoperative recognition of CSF leak is imperative in order to ensure timely repair and to prevent further complications. Identification of surgical techniques and patient-specific factors contributing an increased risk of postoperative CSF leak is vital. Given the prior intranasal and palatal surgery, various preoperative reconstruction options must be considered.