Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study

Schwaiger, Michael; Wallner, Jürgen; Edmondson, Sarah‐Jayne; Mischak, Irene; Rabensteiner, Jasmin; Tse, Gary; Zemann, Wolfgang

doi:10.1016/j.jcms.2020.07.015

Cited by 14 publications

(37 citation statements)

References 34 publications

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“…They found that male had more blood perfusion than female. Schwaiger et al [ 40 ] investigated the blood loss in orthognathic surgery, and male was found to be associated with significantly increased bleeding volumes in the 2-jaw surgery. Moreover, male revealed more hidden blood loss than female in SSRO.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review

Lee

Lin

Hsu

et al. 2021

BioMed Research International

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Purpose. The purpose of the present study was to review the literature regarding the blood loss and postoperative pain in the isolated sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). Materials and Methods. Investigating the intraoperative blood loss and postoperative pain, articles were selected from 1970 to 2021 in the English published databases (PubMed, Web of Science, and Cochrane Library). Article retrieval and selection were performed by two authors, and they independently evaluated them based on the eligibility criteria. The articles meeting the search criteria had especially at least 30 patients. Results. In the review of intraoperative blood loss, a total of 139 articles were retrieved and restricted to 6 articles (SSRO: 4; IVRO: 2). In the review of postoperative pain, a total of 174 articles were retrieved and restricted to 4 articles (SSRO: 3; IVRO: 1). The mean blood loss of SSRO and IVRO was ranged from 55 to 167 mL and 82 to 104 mL, respectively. The mean visual analog scale (VAS) scores of the first postoperative day were 2 to 5.3 in SSRO and 2.93 to 3.13 in IVRO. The mean VAS scores of the second postoperative day were 1 to 3 in SSRO and 1.1 to 1.8 in IVRO. Conclusion. Compared to traditional SSRO, IVRO had a significantly lower amount of blood loss. However, the blood transfusion is not necessary in a single-jaw operation (SSRO or IVRO). Postoperative pain was similar between SSRO and IVRO.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review

Lee

Lin

Hsu

et al. 2021

BioMed Research International

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“…Male and female patients with skeletal dentofacial deformities scheduled for bimaxillary surgery were selected according to defined inclusion and exclusion criteria. Exclusion criteria entailed (1) additional surgical procedures performed in the same operative session (including genioplasty); (2) oral intake of anticoagulants; (3) coagulopathies; (4) age under 18; (5) cleft lip and palate; (6) connective tissue disorders and (7) ASA grade 3 or 4.…”

Section: Methodsmentioning

confidence: 99%

“…While generally considered to be a safe surgical field, orthognathic surgical procedures continue to be linked to large intra-and perioperative bleeding volumes conferring various negative effects for a patient [1][2][3]. Especially with regard to bimaxillary surgery, involving skeletal repositioning of the upper and lower jaw, blood loss has frequently been described as excessive [4][5][6]. Reasons for this particularly refer to the rich vascular anatomy of the midface, the limited surgical accessibility to this area, in combination with the complexity of the procedure and the wide surgical exposure needed [6].…”

Section: Introductionmentioning

confidence: 99%

“…Especially with regard to bimaxillary surgery, involving skeletal repositioning of the upper and lower jaw, blood loss has frequently been described as excessive [4][5][6]. Reasons for this particularly refer to the rich vascular anatomy of the midface, the limited surgical accessibility to this area, in combination with the complexity of the procedure and the wide surgical exposure needed [6]. Orthognathic surgical procedures are elective by nature; therefore, a high quality of care with minimum associated risks is a necessity.…”

Section: Introductionmentioning

confidence: 99%

“…In this context, patient gender has frequently been discussed as a major contributing factor in terms of the amount of blood loss to be expected, whereby controversial findings were reported. Several authors have stated that male gender is associated with higher bleeding volumes in comparison to female gender [6,[13][14][15][16]. It has previously been suggested that an ampler haemostatic profile in females in comparison with males may trigger gender-specific differences with regard to the bleeding volumes observed [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Gender-specific differences in haemostatic parameters and their influence on blood loss in bimaxillary surgery

et al. 2022

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Objective The objectives of this prospective cohort study were to establish gender-related differences in blood loss and haemostatic profiles associated with bimaxillary surgery. In addition, we aimed to identify if any gender differences could be established which might help predict blood loss volume. Materials and methods Fifty-four patients (22 males; 32 females) undergoing bimaxillary surgery for skeletal dentofacial deformities were eligible for inclusion. Blood samples were taken 1 day preoperatively and 48 h postoperatively for detailed gender-specific coagulation analysis incorporating global coagulation assays (endogenous thrombin potential) and specific coagulation parameters. Blood loss was measured at two different time points: (1) the end of surgery, visible intraoperative blood loss (IOB) using ‘subtraction method’; and (2) 48 h postoperatively perioperative bleeding volume (CBL-48 h) using ‘haemoglobin-balance method’ and Nadler’s formula. Correlation and regression analyses were performed to identify relevant parameters affecting the amount of blood loss. Results Significant differences in IOB and CBL-48 h were observed (p < 0.001). Men had higher IOB versus women, lacking statistical significance (p = 0.056). In contrast, men had significantly higher CLB-48 h (p = 0.019). Reduced CBL-48 h was shown to be most closely associated with the level of Antithrombin-III being decreased in females. Conclusions Male gender is associated with higher IOB and CBL-48 compared with females. Gender does not affect IOB regarding haemostatic profile but does correlate strongly with procedure length. Conversely, CBL-48 is closely associated with gender-specific imbalances in the anticoagulant system. Clinical relevance Knowledge of gender-related differences will help clinicians establish predictive factors regarding excessive blood loss in orthognathic surgery and identify at-risk patients.

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The use of an ultrasonic curettage device in orthognathic surgery decreases surgery-related blood loss

Sakuma¹,

Hasebe²,

Takeuchi³

et al. 2022

Heliyon

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Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study

Cited by 14 publications

References 34 publications

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review

Gender-specific differences in haemostatic parameters and their influence on blood loss in bimaxillary surgery

The use of an ultrasonic curettage device in orthognathic surgery decreases surgery-related blood loss

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