Maxillary Sinusitis After Double-Jaw Surgery: A Real Case Study on Causes, Treatment, and OMFS-ENT Collaboration (Orthognathic Surgery Complications & Inflammation)
- Dr. Park
- 1 day ago
- 5 min read
Hello, I am Dr. Park Jong-cheol, an Oral and Maxillofacial Surgeon.
Today, I'd like to share a real treatment case of maxillary sinusitis (a type of sinus infection), which is one of the potential complications many people are curious about after orthognathic surgery (double-jaw surgery). I will also explain appropriate treatment methods and why collaboration between related medical departments is crucial.
Orthognathic surgery is a procedure that significantly improves both function and aesthetics by repositioning the upper and lower jaws. However, like all surgeries, it carries the possibility of various side effects or complications, and inflammation in the maxillary sinus post-surgery is an issue that, although uncommon, can occasionally occur. Most patients receive prompt and appropriate care at the hospital where they underwent surgery. However, some individuals face difficulties due to various circumstances. The patient I'm introducing today came to me for treatment because the clinic where they had their original surgery had closed down.
Long-standing Discomfort: The Patient's Journey and Initial Condition
The patient I'm presenting today underwent orthognathic surgery (Le Fort I maxillary osteotomy, SSRO mandibular surgery), along with genioplasty (chin surgery) and zygoma reduction (cheekbone surgery), at a private plastic surgery clinic approximately 12 years ago, in 2012.
A long time later, in 2024, the patient noticed a small opening (fistula) in their oral cavity and suspected maxillary sinusitis, which led the patient to visit a university hospital. However, the decision about which department to seek primary treatment from—the Ear, Nose, and Throat (ENT) or the Oral and Maxillofacial Surgery (OMFS)—was unclear, leading the patient to eventually seek further evaluation at our clinic after facing uncertainty regarding clear guidance.
Upon first visit, CT scans revealed a bone defect (missing bone) in the area of the previous maxillary surgery. Unfortunately, the left maxilla, which had no inflammation, showed even more severe bone defect than the right side. In the CT image, the black area within the yellow circle indicates the empty space where bone is missing.
The cross-sectional CT image clearly confirmed that the right maxillary sinus was filled with inflammation.
Maxillary Sinusitis After Orthognathic Surgery: What Causes It?
The primary causes of maxillary sinusitis after orthognathic surgery can be summarized as follows:
Anatomical Changes in the Maxillary Sinus: The maxillary sinus is an empty space within the facial bones next to the nose. It connects to the nasal cavity through a small opening (natural ostium), allowing for ventilation and mucus drainage. During orthognathic surgery, repositioning the maxilla can alter the structure of the maxillary sinus. If this natural ostium becomes blocked post-surgery, mucus cannot drain properly, accumulates, and can lead to bacterial growth, resulting in inflammation, or sinusitis. In this patient's case, the CT scan showed a relatively clear left natural ostium (yellow arrow), but the right ostium, where inflammation was severe, was blocked.
Status of Maxillary Sinus Ostium (Natural Opening) After Orthognathic Surgery Issues with Surgical Plates and Screws: Small metal plates and screws are used to fix the bone segments in place during orthognathic surgery. If the maxillary bone has insufficient support or if healing in the surgical area is compromised, continuous stress from forces like chewing can be exerted on these plates and screws. This can lead to resorption (dissolving) of the surrounding bone or trigger an inflammatory response. Consequently, inflammatory substances can easily adhere around the plates, leading to chronic inflammation. This patient also had a noticeable bone defect in the maxillary area on CT scans, although, fortunately, the patient did not complain of significant functional problems such as chewing.
In this patient's case, it was difficult to definitively determine which of these two causes was the primary factor. Therefore, for successful treatment, it was crucial to consider both possibilities and establish a treatment plan that addressed the root causes.
A Multifaceted Approach to Effective Treatment: Collaboration Between OMFS and ENT
In October 2024, after an in-depth consultation with the patient, we established a treatment plan. The first consideration was removing the metal plates used in the maxillary surgery. However, even if the plates were removed, if the maxillary sinus ostium remained blocked, the sinus inflammation would likely persist, and the oral fistula could also continue. Therefore, we determined that an ENT consultation was necessary to evaluate and improve the condition of the maxillary sinus before proceeding with OMFS treatment, so we referred the patient to an ENT specialist.
Subsequently, the patient received antibiotic therapy and sinus irrigation treatments from the ENT department for about three months, until January 2025. However, despite this conservative treatment, there was no significant improvement in the maxillary sinusitis. Ultimately, the decision was made for the patient to undergo Functional Endoscopic Sinus Surgery (FESS) with the ENT specialist.
Accordingly, in March 2025, I first performed the surgery to remove the metal plates used in the patient's original orthognathic surgery. One week later, the patient underwent FESS performed by the ENT specialist. This staged and collaborative treatment approach effectively eliminated the inflammation within the maxillary sinus and restored its ventilation function.
Treatment Outcome: A Clear Sinus and Future Management
Comparing the CT images before and after the plate removal surgery:
The bone defect in the right maxillary area (yellow circle) could be seen more clearly after the surgery. Meanwhile, considering the stable union of the maxillary bone, some of the metal plates in the left posterior tooth region were intentionally left in place.
The cross-sectional CT images taken after the FESS showed that the right maxillary sinus, previously filled with inflammation, was now clear and significantly improved (yellow circle). Simultaneously, the area of bone defect (yellow arrow) was also more clearly visible than before treatment. The patient is currently recovering well without discomfort from maxillary sinusitis.
This case once again highlighted the importance of meticulous bone grafting, when necessary, during surgeries like the Le Fort I maxillary osteotomy. This helps minimize postoperative bone defects and create a stable healing environment.
Concerned About Sinusitis After Orthognathic Surgery? Consult a Specialist.
If maxillary sinusitis (a sinus infection) occurs after orthognathic surgery, it can cause significant discomfort in daily life due to various symptoms such as nasal congestion, yellowish nasal discharge, facial pain, and postnasal drip (mucus dripping down the back of the throat). Furthermore, patients often feel confused about which medical department to consult and what kind of treatment to receive.
Generally, maxillary sinusitis falls within the primary domain of ENT specialists. However, in cases related to orthognathic surgery, OMFS evaluation and treatment are often concurrently required to address issues such as the condition of the surgical site, problems with metal plates, and bone defects. Therefore, it is crucial for specialists in these two fields to collaborate closely to establish an optimal treatment plan tailored to each patient's individual condition and to manage the treatment together.
If you are experiencing similar symptoms after orthognathic surgery, do not hesitate to consult an Oral and Maxillofacial Surgeon for an accurate diagnosis and appropriate treatment plan. I sincerely hope this posting helps patients with similar difficulties choose a more effective treatment process and, if necessary, regain their health through smooth interdepartmental collaboration.
Orthognathic surgery can sometimes involve a complex recovery process. However, if problems arise, identifying the exact cause and addressing it correctly can lead to satisfactory results. I will always prioritize the health and happiness of my patients and do my best in providing care. Thank you.
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