Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Intraoperative blood loss and surgical time according to the direction of maxillary movement

  • Kim, Hyo Seong (Department of Plastic and Reconstructive Surgery, Myongji Hospital) ;
  • Son, Ji Hwan (Department of Plastic and Reconstructive Surgery, Myongji Hospital) ;
  • Chung, Jee Hyeok (Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital) ;
  • Kim, Kyung Sik (Department of Plastic and Reconstructive Surgery, Myongji Hospital) ;
  • Choi, Joon (Department of Plastic and Reconstructive Surgery, Myongji Hospital) ;
  • Yang, Jeong Yeol (Department of Plastic and Reconstructive Surgery, Myongji Hospital)
  • Received : 2020.05.20
  • Accepted : 2020.07.10
  • Published : 2020.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Excessive bleeding is one of the most severe complications of orthognathic surgery (OGS). This study investigated the associations of intraoperative blood loss and surgical time with the direction of maxillary movement. Methods This retrospective study involved patients who underwent OGS from October 2017 to February 2020. They were classified based on whether maxillary setback was performed into groups A1 and B1, respectively. Relative blood loss (RBL, %) was used as an indicator to compare intraoperative blood loss between the two groups. The surgical time of the two groups was also measured. Subsequently, the patients were reclassified based on whether posterior impaction of the maxilla was performed into groups A2 and B2, respectively. RBL and surgical time were measured in the two groups. Simple linear and multiple regression analyses were performed. P-values <0.05 were considered to indicate statistical significance. Results Eighteen patients were included. The RBL and surgical time for the groups were: A1, 13.15%±5.99% and 194.37±42.04 minutes; B1, 12.41%±1.89% and 196.50±46.07 minutes; A2, 13.94%±3.82% and 201.00±39.70 minutes; and B2, 9.61%±3.27% and 188.84±38.63 minutes, respectively. Only RBL showed a statistically significant difference between the two groups (A2 and B2, P=0.04). Conclusions Unlike maxillary setback, posterior impaction of the maxilla showed a significant association with RBL during surgery. When performing posterior impaction of the maxilla, clinicians need to pay particular attention to surgery and postoperative care.

Keywords

References

  1. Kramer FJ, Baethge C, Swennen G, et al. Intra- and perioperative complications of the LeFort I osteotomy: a prospective evaluation of 1000 patients. J Craniofac Surg 2004;15: 971-7. https://doi.org/10.1097/00001665-200411000-00016
  2. Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg 2001;59:1128-36. https://doi.org/10.1053/joms.2001.26704
  3. Lanigan DT, Hey JH, West RA. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies. J Oral Maxillofac Surg 1990;48:561-73. https://doi.org/10.1016/s0278-2391(10)80468-9
  4. Politis C, Kunz S, Schepers S, et al. Obstructive airway compromise in the early postoperative period after orthognathic surgery. J Craniofac Surg 2012;23:1717-22. https://doi.org/10.1097/SCS.0b013e31826beeb2
  5. Varol A, Basa S, Ozturk S. The role of controlled hypotension upon transfusion requirement during maxillary downfracture in double-jaw surgery. J Craniomaxillofac Surg 2010;38:345-9. https://doi.org/10.1016/j.jcms.2009.10.012
  6. Chan W, Smith DE, Ware WH. Effects of hypotensive anesthesia in anterior maxillary osteotomy. J Oral Surg 1980;38: 504-8.
  7. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery 1962;51:224-32.
  8. Gulsen A, Sibar S, Ozmen S. Orthognathic treatment of facial asymmetry due to temporomandibular joint ankylosis. Arch Plast Surg 2018;45:74-9. https://doi.org/10.5999/aps.2016.01774
  9. Park RH, Myers PL, Langstein HN. Beliefs and trends of aesthetic surgery in South Korean young adults. Arch Plast Surg 2019;46:12-6.
  10. Rosen HM. Aesthetic orthognathic surgery. In: Mathes SJ, Hentz VR, editors. Plastic surgery. Volume 2. 2nd ed. Philadelphia: Mosby Elsevier; 2005. p. 649
  11. Borah GL, Rankin MK. Appearance is a function of the face. Plast Reconstr Surg 2010;125:873-8. https://doi.org/10.1097/PRS.0b013e3181cb613d
  12. Eshghpour M, Mianbandi V, Samieirad S. Intra- and postoperative complications of Le Fort I maxillary osteotomy. J Craniofac Surg 2018;29:e797-803. https://doi.org/10.1097/scs.0000000000004828
  13. Ueki K, Marukawa K, Shimada M, et al. The assessment of blood loss in orthognathic surgery for prognathia. J Oral Maxillofac Surg 2005;63:350-4. https://doi.org/10.1016/j.joms.2004.05.226
  14. Cutbirth M, Van Sickels JE, Thrash WJ. Condylar resorption after bicortical screw fixation of mandibular advancement. J Oral Maxillofac Surg 1998;56:178-82. https://doi.org/10.1016/S0278-2391(98)90863-1
  15. Ward JL, Garri JI, Wolfe SA. Posterior movements of the maxilla. J Craniofac Surg 2007;18:882-6. https://doi.org/10.1097/scs.0b013e3180684778
  16. Van de Perre JP, Stoelinga PJ, Blijdorp PA, et al. Perioperative morbidity in maxillofacial orthopaedic surgery: a retrospective study. J Craniomaxillofac Surg 1996;24:263-70. https://doi.org/10.1016/S1010-5182(96)80056-4
  17. Mayrovitz HN, Regan MB. Gender differences in facial skin blood perfusion during basal and heated conditions determined by laser Doppler flowmetry. Microvasc Res 1993;45: 211-8. https://doi.org/10.1006/mvre.1993.1019
  18. Pineiro-Aguilar A, Somoza-Martin M, Gandara-Rey JM, et al. Blood loss in orthognathic surgery: a systematic review. J Oral Maxillofac Surg 2011;69:885-92. https://doi.org/10.1016/j.joms.2010.07.019
  19. Kretschmer W, Koster U, Dietz K, et al. Factors for intraoperative blood loss in bimaxillary osteotomies. J Oral Maxillofac Surg 2008;66:1399-403. https://doi.org/10.1016/j.joms.2008.01.060
  20. Yu CN, Chow TK, Kwan AS, et al. Intra-operative blood loss and operating time in orthognathic surgery using induced hypotensive general anaesthesia: prospective study. Hong Kong Med J 2000;6:307-11.
  21. Schaberg SJ, Kelly JF, Terry BC, et al. Blood loss and hypotensive anesthesia in oral-facial corrective surgery. J Oral Surg 1976;34:147-56.
  22. Al-Sebaei MO. Predictors of intra-operative blood loss and blood transfusion in orthognathic surgery: a retrospective cohort study in 92 patients. Patient Saf Surg 2014;8:41. https://doi.org/10.1186/PREACCEPT-4938875171344463
  23. Rohling RG, Haers PE, Zimmermann AP, et al. Multimodal strategy for reduction of homologous transfusions in cranio-maxillofacial surgery. Int J Oral Maxillofac Surg 1999;28:137-42.
  24. Salma RG, Al-Shammari FM, Al-Garni BA, et al. Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery. Oral Maxillofac Surg 2017;21:259-66. https://doi.org/10.1007/s10006-017-0626-1
  25. Billett HB. Hemoglobin and hematocrit. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990.
  26. Choi BK, Yang EJ, Oh KS, et al. Assessment of blood loss and need for transfusion during bimaxillary surgery with or without maxillary setback. J Oral Maxillofac Surg 2013;71: 358-65. https://doi.org/10.1016/j.joms.2012.04.012