Changes in the Facial Profile due to Prolonged Refractory Nonunion After Le Fort I Osteotomy: Case Reports and Review of the Literature

ABSTRACT Background Maxillary nonunion is a rare complication that occurs after Le Fort I osteotomy. We report two cases of refractory nonunion after osteotomy that required a second surgery with refixation and bone grafting. Case Presentation A 30‐year‐old woman had a mandibular prognathism‐like appearance due to a counterclockwise rotation of the maxillo‐mandibular complex due to long‐term maxillary nonunion. Although surgical stabilisation was performed using titanium plates, the nonunion remained. As there was no hope of improving the appearance of her face, refusion surgery was performed approximately 5 years after refixation with autologous bone grafts using titanium and biodegradable fixation systems. At the 2‐year follow‐up, the maxillary nonunion had healed clinically and radiographically. In the other case, a 27‐year‐old woman had undergone bimaxillary osteotomy at another hospital 2 years prior and visited our department because of upset of the maxilla. Due to plate rupture and counterclockwise rotation of the maxilla and mandible, she underwent redivision and refixation surgery with autologous bone grafts using titanium and biodegradable fixation systems on both the maxilla and mandible. Conclusions Because maxillary nonunion causes the maxillo‐mandibular complex to rotate counterclockwise, resulting in a facial profile similar to that of mandibular prognathism, it is important to consider not only refixation of the maxilla but also reosteotomy and refixation of both the maxilla and mandible in some cases.