Factors That Determine Intraoperative Blood Loss in Bimaxillary Osteotomies and the Need for Preoperative Blood Preparation

doi:10.1016/j.joms.2011.02.085

Journal of Oral and Maxillofacial Surgery

Volume 69, Issue 11, November 2011, Pages e456-e460

https://doi.org/10.1016/j.joms.2011.02.085 Get rights and content

Purpose

To define factors that influence blood loss in bimaxillary osteotomies and the need for blood preparation at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand.

Patients and Methods

We retrospectively studied 208 patients who underwent bimaxillary osteotomies during 2005 to 2009. Possible factors for intraoperative blood loss such as age, body weight, gender, operative time, experience of the surgeons, and different operative procedures were statistically analyzed.

Results

Female patients had a significantly higher percentage of blood loss from allowable blood loss than male patients (P = .006). Experience of the surgeons had a significant influence on blood loss (P = .02) and operative time (P < .001). No significant difference in blood loss was found among the 4 groups classified by operation (P = .852). Simple regression analysis showed a significantly positive correlation between blood loss and duration of operation (R² = 0.15, P < .001). There was no correlation between blood loss and patient age (P = .35).

Conclusion

The factors that influence blood loss include patient gender, experience of the surgeon, and operative time. Blood preparation should be considered in women, especially small individuals in whom a long operative time is expected and who are being operated on by an inexperienced surgeon. Because of the low rate of transfusion, a group-and-save policy is appropriate.

Section snippets

Patients and Methods

After approval by the Committee on Human Rights Related to Human Experimentation, Mahidol University, 210 patients undergoing bimaxillary orthognathic surgery at the Department of Surgery, Faculty of Dentistry, Mahidol University, from January 2005 to December 2009, were analyzed retrospectively. Two were excluded because of incomplete data. Of the 208 patients, 133 were female patients and 75 were male patients. All patients underwent a standard anesthetic technique with controlled hypotensive

Results

From 2005-2009, 133 female and 75 male patients with a mean age of 25.9 ± 5.5 years (range, 16-44 years) were compared. All patients were healthy (American Society of Anesthesiologists status I). The mean body weight for all patients was 56.6 ± 12.2 kg (range, 38-112 kg). The mean operating time for all procedures was 292.4 ± 64.7 minutes (range, 150-510 minutes), and the mean blood loss was 854.8 ± 442.8 mL (range, 200-3,400 mL). The female-male ratio was 1.77:1. Mean estimated blood loss for

Discussion

During the past year, many methods have reduced the blood loss for bimaxillary osteotomies dramatically, such as hypotensive anesthesia,3, 6, 7, 8 the use of tranexamic acid,9, 10 and the head-up position during the operation. However, the amount of blood loss has varied from center to center and still shows a wide range. Samman et al¹¹ and Dhariwal et al¹² reported a blood loss from 50 to 5,000 mL and 50 to 1,500 mL, respectively. From our study, the blood loss from 2005 to 2009 was 200 to

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Intraoperative blood loss and the need for preoperative blood preparations in transgender women undergoing facial feminization surgeries: implications for surgeons
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The aim of this retrospective study was to assess blood loss during facial feminization surgeries and to evaluate blood transfusion requirements. Data from the medical records of all male-to-female transgender patients (transwomen) treated with gender affirming hormones and undergoing facial feminization surgeries were analysed. The total blood loss was calculated based on the haemoglobin balanced method. Twenty transwomen (average age of 25.9 years) were enrolled. Group 1 included 10 transwomen who underwent cranioplasty, genioplasty, and mandibular angles refining, group 2 included six transwomen who underwent cranioplasty and genioplasty, and group 3 included four transwomen who underwent mandibular angles refining and genioplasty. The median calculated blood loss for groups 1, 2, and 3 was 1159.7 ml, 828.5 ml, and 546.2 ml, respectively. The group differences in surgical time, intraoperative fluid amounts, and calculated blood loss volumes were significant. None of the patients required an intraoperative blood transfusion and the hormonal treatment had no effect on the amount of calculated blood loss. Hence, blood loss during facial feminization surgeries is well controlled and does not lead to life-threatening events, precluding the possibility of providing generalized recommendations for preoperative blood transfusion preparations.
Bone marrow space volume of the mandible influencing intraoperative blood loss in bilateral sagittal split osteotomy: A pilot Study
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Citation Excerpt :
Many studies have focused on predicting blood loss during orthognathic surgery [26]. Previous reports have mentioned factors that influence blood loss during surgery, including operating time, surgical procedure, and surgeon experience [2, 3, 5]. Furthermore, patient factors such as age, sex, weight, BMI, and thromboelastography have also been reported to influence blood loss [3, 5, 19, 27].
The aim of this study was to investigate whether the bone marrow space volume of the mandible affects blood loss during bilateral sagittal split osteotomy (BSSO).
Sixteen patients who underwent BSSO in our hospital were included in this study. Bone marrow space volume of the mandible was measured by analyzing images from computed tomography. Blood loss during BSSO was measured by weighing gauze, measuring suctioned blood, and adjusting for the volume of irrigation solution used during BSSO.
Mean blood loss during BSSO for the 16 patients was 200.5 ml, and patients were divided into: Group I, with less than mean blood loss; and Group II, with greater than mean blood loss. Total bone marrow space volume was significantly greater in Group II (12,450.7 ± 2644.3 mm³) than in Group I (9130.3 ± 3005.8 mm³; P<0.05).
A correlation between bone marrow space volume and blood loss during BSSO was suggested, and these results are beneficial for surgeons planning and preparing the orthognathic surgery.
Is Cleft Lip or Palate a Risk Factor for Perioperative Complications in Orthognathic Surgery?
2022, Journal of Oral and Maxillofacial Surgery
Perioperative outcomes following cleft orthognathic surgery are not well established. The purpose of this study was to compare the incidence of orthognathic specific complications (OSCs) in patients with and without cleft lip and/or palate.
The American College of Surgeons National Surgical Quality Improvement Program adult and pediatric databases were used to enroll patients undergoing orthognathic surgery. The primary predictor variable was a prior diagnosis of cleft lip and/or palate: cleft versus noncleft. The primary outcome variable was OSCs (yes/no) within 30 days of the index operation. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between cleft status and OSCs.
The study sample was composed of 1,149 subjects: 98 in the cleft group and 1,051 in the noncleft group. The incidence of OSCs was 6.1 and 4.7% for the cleft and noncleft groups, respectively (P = .461). After adjusting for age, cleft status, bone grafting, segmentation of the maxilla, and history of bleeding disorder, classification as American Society of Anesthesiologists (ASA) III (P = .002, odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.63-9.40), ASA IV (P = .039, OR = 9.47, 95% CI 1.12-80.4), and isolated mandibular osteotomies (P = .006, OR = 3.23, 95% CI 1.40-7.48) were independent predictors of OSCs. Length of stay was 1.66 ± 1.14 days compared to 1.37 ± 3.74 days for the cleft and noncleft groups, respectively (P = .443).
There was no significant difference in the incidence of perioperative OSCs and length of hospital stay between cleft and noncleft patients. Cleft status was not an independent predictor of OSCs; instead, greater ASA classification and isolated mandibular osteotomies were the only predisposing factors. Patients with clefts undergoing orthognathic surgery do not have an increased risk of short-term OSCs within the limitations of this study.
Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study
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Citation Excerpt :
These differences may be explained by distinctions in terms of the study design, pooling of various treatment modalities for statistical analysis, as well as the use of different methods and timings to determine blood loss. Additionally, the length of the surgical procedure (Thastum et al., 2016), the surgeon's skills (Kretschmer et al., 2008; Rummasak et al., 2011) and patient-specific parameters such as age, gender and body mass index (BMI) (Kretschmer et al., 2008; Rummasak et al., 2011; Al-Sebaei, 2014; Olsen et al., 2016), all potentially influencing blood loss, were shown to differ between studies. The aforementioned divergences related to respective study designs and study variables inevitably create a heterogeneous study population and therefore, interfere with the comparability of results.
The aim of this prospective observational study was to investigate the parameter ‘hidden blood loss’ (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively.
Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the ‘haemoglobin balance method’.
Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery.
82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (±265.9) in the bimaxillary group and 346.9 ml (±271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0.001).
HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes.
The efficacy of low dose intravenous tranexamic acid on intraoperative blood loss in bimaxillary surgery
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The aim of this study was to identify the effect of tranexamic acid on intraoperative blood loss during bimaxillary surgery.
A retrospective cohort study was performed in patients underwent bimaxillary osteotomy under hypotensive anesthesia with nicardipine. Twenty eight patients were divided into two groups, a standard group did not receive tranexamic acid, a study group received a single dose of 10 mg/kg of tranexamic acid, preoperatively. The operation and surgeons were matched in both groups. General anesthesia was performed by one anesthesiologist. Data collection included the operation time, preoperative hematocrit, postoperative hematocrit, intraoperative blood loss, and any blood transfusion. The analysis were divided into two sub groups, a total osteotomy of Le Fort I with mandibular surgery, and a segmented osteotomy of Le Fort I with mandibular surgery.
The intraoperative blood loss during bimaxillary surgery in the study group was lower than the standard group but without statistical significant difference(664.29 $\pm$ 213.42 mL vs 850.00 $\pm$ 356.26 mL)(P = 0.05). The intraoperative blood loss and blood transfusion during segmented osteotomy of Le Fort I with mandibular surgery was reduced significantly in the study group compared with the standard group(650.00 $\pm$ 217.94 mL vs 1,092.86 $\pm$ 346.92 mL and 0.71 $\pm$ 0.95 units vs 1.57 $\pm$ 0.78 units)(P < 0.05). There were no complications such as nausea, vomiting and other complications in any of the patients.
A single preoperative intravenous administration of 10 mg/kg of tranexamic acid is effective and safe in controlling blood loss in segmented osteotomy of Le Fort I with mandibular surgery.
Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy
2020, Journal of Cranio-Maxillofacial Surgery
The purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy.
In total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed.
The mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003).
The PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.

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Craniomaxillofacial deformity/cosmetic surgeryFactors That Determine Intraoperative Blood Loss in Bimaxillary Osteotomies and the Need for Preoperative Blood Preparation

Purpose

Patients and Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Craniomaxillofacial deformity/cosmetic surgery
Factors That Determine Intraoperative Blood Loss in Bimaxillary Osteotomies and the Need for Preoperative Blood Preparation