Acute upper airway constriction is the most critical of all respiratory disorders and its treatment demands prompt action. Acute upper airway constriction due to complications such as hemorrhage, pharyngeal edema, and upper airway narrowing can occur after maxillofacial surgery. We describe a case of acute upper airway constriction that occurred after bimaxillary distraction. The patient was a 12-year-old girl with hemifacial microsomia due to Goldenhar syndrome. The right mandibular body at the distal region of the first molar and maxillary alveolus underwent complete osteotomy. Intraoral-type distraction devices were set in place. There were no complications during surgery; however she complained of dyspnea and had signs of acute upper airway constriction, such as disturbed sleep and severe swelling from the submandibular to the cervical region, on the first postoperative day. X-ray CT scans showed obvious edema in the submandibular space and parapharyngeal space of the oropharynx. Emergency nasal airway intubation was performed, and a drainage route was placed at the site of mandibular osteotomy. Intravenous steroids were given. After drainage of the hematoma, her respiratory condition improved immediately, and X-ray CT scans showed decreased upper airway constriction the next day. We emphasized that postoperative evaluation of the airway and respiratory management have an important role in maxillofacial surgery.
