Auditory Outcomes in Patients Undergoing Orthognathic Surgery: An Analysis of Middle Ear Disease.

OBJECTIVE

To characterize postoperative Eustachian tube dysfunction (ETD) and middle ear pathology following Le Fort I osteotomy.

STUDY

DESIGN

Retrospective cohort study.

SETTING

Single tertiary care center.

METHODS

Patients who underwent Le Fort I (LF1) osteotomy between 2000 and 2022 were identified using CPT codes. Audiometric, tympanometric, clinical, and surgical data were extracted. ETD was defined by abnormal tympanometry (type B or C), an air-bone gap >10 dB, or PE tube placement. Patients were stratified by preoperative ETD status and classified by postoperative phenotype.

RESULTS

Among 2316 surgical patients, 151 had audiometric data. 47 patients met criteria for postoperative ETD: 15 had no prior history of ETD, 15 had a remote history of ETD, and 17 had active preoperative ETD within the year preceding Le Fort surgery. The most common phenotype of postoperative ETD was middle ear effusion (49%), followed by objective pressure abnormalities without effusion (17%), symptoms only (15%), cholesteatoma (11%), and complete Eustachian tube stenosis (9%). 28% of patients with postoperative ETD required PE tube placement and 13% required more advanced otologic surgery. Notably, 2 patients without a history of cleft palate or craniofacial syndrome developed permanent ET pathology.

CONCLUSIONS

ETD may occur as a complication of Le Fort I osteotomy, even in patients without pre-existing otologic disease.

LEVEL OF EVIDENCE: Level 4-Case series & retrospective cohort studies.