Otologic Complications Following LeFort Surgery: Analysis of Postoperative Eustachian Tube Dysfunction

Introduction: LeFort I osteotomy, a cornerstone of midface reconstruction, involves surgical proximity to the Eustachian tube. This study evaluates postoperative Eustachian tube dysfunction (ETD), a poorly understood and underrecognized complication of LeFort surgery.

Methods: A retrospective cohort study was conducted at a tertiary care center, analyzing patients from 2000-2024 who underwent LeFort I osteotomy. Data sources included audiometry, tympanometry, imaging, operative reports, visit notes. Descriptive and case-based analyses were performed to characterize complications.

Results: Out of 2,316 LeFort I osteotomy patients, 113 had postoperative audiograms, of which 34 (1.5% of all LeFort I patients) exhibited postoperative ETD. Of the 34 cases of postoperative ETD, 15 were de novo ETD (44.1%), 13 had a remote history of ETD without preoperative symptoms (38.2%), and 6 had active ETD within one year prior to LeFort surgery (17.6%). Middle ear effusion was the most common postoperative finding, occurring in 52.9% (18/34) of cases, with higher prevalence among remote ETD cases (69.2%; 9/13). Isolated pressure abnormalities were observed in 17.6% (6/34) of patients. Severe complications were rare but included complete stenosis of the Eustachian tube in 5 patients, and bilateral cholesteatoma in 1 patient. Management strategies included ear tube placement in 38.2% (13/34) of patients, medical management in 8.8% (3/34), and additional surgery in 8.8% (3/34).

Conclusions: ETD and associated middle ear pathology are rare but underrecognized complications of LeFort I osteotomy surgery. These findings provide critical insight into the risks associated with midface reconstruction, emphasizing the importance of patient counseling and long-term follow-up to address postoperative auditory concerns effectively.