Case Report
Volume 17 Issue 8 - 2018
Lower Extremity Compartment Syndrome Associated with Hypotensive General Anesthesia for Orthognathic Surgery: A Case Report and Review
Abdullah Alatel1, Abdullatif Abuhaimed2, Ahmed Alasraj3* and Dania M Almadi3
1Consultant Oral and Maxillofacial Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
2Resident, Department of Oral and Maxillofacial Surgery, Riyadh, Saudi Arabia
3Dental Interns, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
*Corresponding Author: Ahmed Alasraj, Dental Interns, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
Received: June 29, 2018; Published: July 30, 2018
Citation: Ahmed Alasraj., et al. “Lower Extremity Compartment Syndrome Associated with Hypotensive General Anesthesia for Orthognathic Surgery: A Case Report and Review”. EC Dental Science 17.8 (2018): 1434-1437.
Abstract
Background: Compartment syndrome has been reported in surgical patient. However, it’s seldom reported in orthognathic cases.
Clinical Case: A 31 years old man presented with restricted maxillary growth as well as a hypoplastic maxilla. He was medically fit and was not aware of any medical conditions. He was prepared for a LeFort I osteotomy advancement as well as mandibular setback and bilateral alveolar bone graft.
Patient was secured in the supine position. Hypotensive anesthesia was maintained. Lowest systolic blood pressure being 70 mmHg and lowest diastolic blood pressure being 40 mmHg.
Day one post op, He complained of pain left leg pain. Mild swelling with no color change noticed. Weak dorsiflexion was noticed. No abnormal sensation was detected. DVT was ruled out using doppler test.
Day two, Pain extended to the anterior compartment of the left leg. Passive motion of the toe was observed. Patient was unable to dorsiflex the left toe and ankle. He was also unable to ever the ankle but was able to invert and plantar flex both ankle and toe. Weak sensation was observed over dorsum of the left foot as well as the left first web space. Good circulation and palpable dorsalis pedis and posterior tibial arteries.
Upon consulting orthopedics, they agreed that the patient needed fasciotomy for anterior compartment syndrome of the left leg as well as ankle foot orthosis for common peroneal palsy.
Spinal anesthesia was administered. Anterior compartment showed a reading of 43 in three different reading. Posterior compartment reading was 17 in three different readings. Releasing the anterior compartment reflected necrosis of the tibialis anterior muscle. Open wound was maintained, and vacuum assisted closure dressing was used. Five days later, the wound debridement and primary closure was achieved.
Patient condition improved, and he no longer reported feeling pain. He was unable to extend ankle or and toe. He was informed that common peroneal palsy needs 3 months of physical therapy to improve.
Keywords: Compartment Syndrome; Hypotensive Anesthesia; Orthognathic Surgery
Copyright: © 2018 Ahmed Alasraj., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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