Pneumocephalus Following Orthognathic Surgery in a Patient with Hemifacial Microsomia: A Rare Case Report

Pneumocephalus is a rare complication in maxillofacial surgery, more commonly associated with craniofacial trauma and neurosurgical procedures. Its occurrence after orthognathic surgery is exceedingly uncommon, particularly in patients with hemifacial microsomia (HFM), where altered craniofacial anatomy increases surgical complexity.

A 19-year-old female with HFM underwent secondary corrective orthognathic surgery including Le Fort I osteotomy, right vertical ramus osteotomy, left sagittal split osteotomy, and genioplasty. Postoperatively, cerebrospinal fluid (CSF) rhinorrhea and pneumocephalus developed and were confirmed radiographically. Conservative management with bed rest, intravenous antibiotics, and neurosurgical supervision resulted in gradual resolution of the CSF leak. Six-month follow-up CT demonstrated complete resolution of pneumocephalus.

Altered craniofacial anatomy in HFM may predispose to skull base injury during pterygomaxillary dysjunction, leading to CSF leakage and pneumocephalus. Early diagnosis and distinction between simple and tension pneumocephalus are essential, as tension pneumocephalus requires urgent intervention. Careful surgical planning and meticulous technique are important in anatomically complex cases.

Pneumocephalus is a rare but significant complication following orthognathic surgery in patients with craniofacial anomalies. Awareness of altered anatomy and prompt multidisciplinary management are essential for favorable outcomes.