Le FortⅠ型骨切り術に合併したmaxillary動静脈瘻に対し血管内塞栓術を行った1例

Embolization of Arteriovenous Fistulae of the Maxillary Artery after Le Fort Ⅰ Osteotomy:A Case Report

Ⅰ．はじめに

　Le FortⅠ型骨切り術は，前下方の頭蓋底から顔面骨を分離させる術式であり，顎変形症の基本的な術式となっている．本術式による顎動脈損傷に伴う動静脈瘻の合併症は，少数の報告例があるのみである．

　今回われわれは，Le FortⅠ型骨切り術を施行した後に発症した，顎動脈の動静脈瘻（maxillary arteriovenous fistula［AVF］）に対して塞栓術を施行し，良好な結果を得たので，文献的考察を加えて，その有効性を報告する．

　BACKGROUND：Le FortⅠ osteotomy, one of the most common techniques applied to correct jaw deformities, is generally considered operatively safe. However, a few articles reported that this procedure can lead to formation of arteriovenous fistulae（AVF）involving the maxillary artery infrequently.

　CASE REPORT：A man in his 40s with a jaw deformity underwent Le FortⅠ osteotomy. Two days later, he noticed pulsating tinnitus in his right ear. Angiography revealed AVF between the proximal part of the maxillary artery（first segment）and the pterygoid plexus. On further evaluation, AVF were embolized with n-butyl-2-cyanoacrylate（NBCA). Obliteration of AVF was confirmed on the final angiography. The tinnitus resolved shortly after the embolization.

　CONCLUSION：Embolization with NBCA is a promising treatment for maxillary AVF after Le FortⅠ osteotomy.