Neuroradiology Case of the Week

Case 5

Lawrence Buadu, MD, PhD, and P-L Westesson, MD, PhD, DDS

Clinical Presentation: A 35-year-old female presented after maxillary surgery with pain and facial swelling.

Radiological Findings: The coronal CT images show characteristic LeFort I osteotomy defects in the anterolateral walls of the maxillary sinus and through the inferior portion of the nasal cavity. These are still in the unhealed stage (Fig. 1). The more posterior coronal images (Fig. 2) demonstrates osteotomy defects of the pterygoid plates bilaterally. There is associated mucosal thickening in the maxillary sinuses bilaterally which is characteristic in the post-operative course of this operation.

Figure 1: Coronal CT images show characteristic LeFort I osteotomy defects (arrows). There are defects in the anterolateral walls of the maxillary sinus and through the inferior portion of the nasal cavity. These are still in the unhealed stage.	Figure 2: More posterior coronal images demonstrate osteotomy defects of the pterygoid plates bilaterally (arrows).

Diagnosis: Status post LeFort I osteotomy

Discussion: LeFort I osteotomy is used to correct maxillofacial deformities. It was first performed in 1927 by Wassmund [1]. It has been used to correct skeletal open bite deformities related to maxillary deficiency or an anterior open bite. LeFort I osteotomy has later been modified to LeFort II and even LeFort III osteotomies.

References:

1. Wassmund M: Lehrbuch der praktischen Chirurgie des Mundes und der Kiefer. 1st bd. Leipzig, Meusser, 1935.