Abstract
Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16–52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type—rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3–17 and 8.8–15.4 g/dL, respectively; p < 0.05). Mean hematocrit values were 41.53 % preoperatively (range 31.3–50.0 %) and 36.56 % postoperatively (range 25–43.8 %) (p < 0.05). Mean blood loss was 274.60 mL (range 45–855 mL). Only two patients required blood transfusion. Although blood loss and transfusion requirements were minimal in the present study, surgical teams should monitor the duration of surgery and follow meticulous protocols to minimize the risks.
Similar content being viewed by others
References
Behrman SJ (1972) Complications of sagittal osteotomy of mandibular ramus. J Oral Surg 30:554–556
Bell WH, Proffit WP, White RP (eds) (1980) Surgical correction of dentofacial deformities. Saunders, Philadelphia
Choi WS, Irwin MG, Samman N (2009) The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial. J Oral Maxillofac Surg 67:125–133
Choi WS, Samman N (2008) Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg 67:687–703
Dhariwal DK, Gibbons AJ, Kittur MA, Sugar AW (2004) Blood transfusion requirements in bimaxillary osteotomies. Br J Oral Maxillofac Surg 42:231–235
Epker BN (1977) Modifications in the sagittal osteotomy of the mandible. J Oral Surg 35:157–159
Fenner M, Kessler P, Holst S, Nkenke E, Neukam FW, Holst AI (2009) Blood transfusion in bimaxillary orthognathic operations: need for testing of type and screen. Br J Oral Maxillofac Surg 47:612–615
Gong SG, Krishnan V, Waack D (2002) Blood transfusions in bimaxillary orthognathic surgery: are they necessary? Int J Adult Orthodon Orthognath Surg 17:314–317
Kessler P, Hegewald J, Adler W, Zimmermann R, Nkenke E, Neukam FW, Fenner M (2006) Is there a need for autogenous blood donation in orthognathic surgery? Plast Reconstr Surg 117:571–576
Kretschmer WB, Baciut G, Bacuit M, Zoder W, Wangerin K (2010) Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures. Br J Oral Maxillofac Surg 48:276–280. doi:10.1016/j.bjoms.2009.07.011
LaBanc JP, Turvey T, Epker BN (1982) Results following simultaneous mobilization of the maxilla and mandible for the correction of dentofacial deformities: analysis of 100 consecutive patients. Oral Surg Oral Med Oral Pathol 54:607–612
Lanigan DT, Hey J, West RA (1991) Hemorrhage following mandibular osteotomies: a report of 21 cases. J Oral Maxillofac Surg 49:713–724
Lanigan DT, West RA (1984) Management of postoperative hemorrhage following the Le Fort I maxillary osteotomy. J Oral Maxillofac Surg 42:367–375
Madsen DE, Ingerslev J, Sidelmann JJ, Thorn JJ, Gram J (2012) Intraoperative blood loss during orthognathic surgery is predicted by thromboelastography. J Oral Maxillofac Surg 70(10):e547–e552. doi:10.1016/j.joms.2012.06.182
Moenning JE, Bussard DA, Lapp TH, Garrison BT (1995) Average blood loss and the risk of requiring perioperative blood transfusion in 506 orthognathic surgical procedures. J Oral Maxillofac Surg 53:880–883
Nath A, Pogrel MA (2005) Preoperative autologous blood donation for oral and maxillofacial surgery: an analysis of 913 patients. J Oral Maxillofac Surg 63:347–349
Nielsen VG, Baird MS, Brix AE, Matalon S (1999) Extreme, progressive isovolemic hemodilution with 5 % human albumin. PentaLyte, or Hextend does not cause hepatic ischemia or histologic injury in rabbits. Anesthesiology 90:1428–1435
Nkenke E, Kessler P, Wiltfang J, Neukam FW, Weisbach V (2005) Hemoglobin value reduction and necessity of transfusion in bimaxillary orthognathic surgery. J Oral Maxillofac Surg 63:623–628
Politano N, Jaskolka M, Blakey G, Turvey T, White R, Phillips C (2012) The effect of preoperative recombinant erythropoietin on postoperative hematocrit level after orthognathic surgery. J Oral Maxillofac Surg 70(11):e625–e630. doi:10.1016/j.joms.2012.07.021
Praveen K, Narayanan V, Muthusekhar MR, Baig MF (2001) Hypotensive anaesthesia and blood loss in orthognathic surgery: a clinical study. Br J Oral Maxillofac Surg 39:138–140
Samman N, Cheung LK, Tong AC, Tideman H (1996) Blood loss and transfusion requirements in orthognathic surgery. J Oral Maxillofac Surg 54:21–24
Turvey TA (1985) Intraoperative complications of sagittal osteotomy of the mandibular ramus: incidence and management. J Oral Maxillofac Surg 43:504–509
Turvey TA (1982) Simultaneous mobilization of the maxilla and mandible: surgical technique and results. J Oral Maxillofac Surg 40:96–99
Ueki K, Marukawa K, Shimada M, Nakagawa K, Yamamoto E (2005) The assessment of blood loss in orthognathic surgery for prognathia. J Oral Maxillofac Surg 63:350–354
van Merkesteyn JP, Groot RH, van Leeuwaarden R, Kroon FH (1987) Intra-operative complications in sagittal and vertical ramus osteotomies. Int J Oral Maxillofac Surg 16:665–670
Walt AJ (1982) American College of Surgeons Committee on Trauma: early care of the injured patient. Saunders, Philadelphia
White RP Jr, Peters PB, Costich ER, Page HL Jr (1969) Evaluation of sagittal split-ramus osteotomy in 17 patients. J Oral Surg 27:851–855
Zellin G, Rasmusson L, Pålsson J, Kahnberg KE (2004) Evaluation of hemorrhage depressors on blood loss during orthognathic surgery: a retrospective study. J Oral Maxillofac Surg 62:662–666
Conflict of interest
None.
Ethical approval
The study protocol was approved by the Research Ethics Committee at Araçatuba Dental School, Universidade Estadual Paulista (UNESP) (protocol no. 2008–02413).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Faverani, L.P., Ramalho-Ferreira, G., Fabris, A.L.S. et al. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery. Oral Maxillofac Surg 18, 305–310 (2014). https://doi.org/10.1007/s10006-013-0415-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10006-013-0415-4