Peripheral facial palsy after set-forward orthognathic surgery: A case report and review of literature

The complications of orthognathic surgery may include but are not limited to postoperative unexpected bleeding, abnormal fractures, infections, and nerve damages. Peripheral facial palsy is rare. We report a case of 23-year-old woman with signs of malocclusion, including pectus excavatum, wrist sign, and thumb sign for Marfan syndrome (MFS) underwent peripheral facial palsy after orthognathic surgery with mandibular advancement. Because cardiovascular, thoracic, and ocular abnormalities were absent, she was suspected of having MFS but not definitively diagnosed. On the other hand, she was diagnosed with a maxillary protrusion with mandibular retrognathism. After presurgical orthodontic treatment, we performed Le Fort I osteotomy and 8 mm advancement by bilateral sagittal split ramus osteotomy. Because the periosteum is vulnerable, we checked the bleeding more are fully and frequently during the operation than usual. The day after the operation, peripheral facial palsy with inability to wrinkle the forehead, blink, and grimace were found. The patient was administered mecobalamin, linear polarized infrared irradiation, and stellate ganglion blocks. The patient was also administered valacyclovir for 6 days and steroid pulse therapy for 7 days. Six months after the operation, the facial palsy had disappeared completely. In 58 previous reports, the facial palsy was induced by the reasons, including the operative procedure, postoperative hematoma, edema, perioperative stress, and tissue vulnerability. In the present case, because of the suspected MFS, tissue vulnerability was considered to be one of the major cause of facial palsy, which should be paid attention more carefully in addition to general causes.