Sub total unilateral oculomotor nerve palsy in a Le Fort I osteotomy

A 35-year-old man developed a pupil sparing palsy of the oculomotor nerve after a standard Le Fort I osteotomy during which there had been more bleeding than usual. No definite cause was found but we suggest that it was caused by ischaemia of the nerve secondary to local injury by haematoma or instrumentation. The anatomical basis for this is discussed.