Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Olsen, Jeppe; Skov, Jane; Ingerslev, Janne; Thorn, Jens Jørgen; Pinholt, Else Marie

doi:10.1016/j.joms.2015.05.031

Cited by 57 publications

(22 citation statements)

References 42 publications

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“…The desire to avoid complications of allogeneic transfusion due to major intraoperative bleeding in the pursuit of safer orthognathic surgery has spurred various investigations into blood loss reduction. However, the majority of these studies discuss only general anesthesia management or hemostatic agent administration [19,20].…”

Section: Discussionmentioning

confidence: 99%

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

et al. 2020

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Major bleeding associated with sagittal split ramus osteotomy (SSRO) involves vessels such as the inferior alveolar, facial, and maxillary arteries and veins, and the retromandibular vein (RMV). The present study aimed to clarify and classify the three-dimensional variations in RMV position and course direction in relation to the mandible. Specimens comprised a total of 15 scientific cadavers, and the relationship between RMV and the mandible lateral and posterior views was observed. We identified 3 patterns on the lateral view, the mean distance between the RMV and the posterior border of the ramus was 3.9 mm at the height of the lingula. A total of five course patterns were identified on the posterior view. In no course pattern, the RMV inferior to the lingula was lateral to its position superior to the lingual. The present findings suggest that it may be possible to predict correlations with intraoperative bleeding risk. Further study is planned using contrast computed tomography in patients with jaw deformity for skeletal classification.

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Section: Discussionmentioning

confidence: 99%

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

et al. 2020

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“…YNB, a mixture of various herbs and plants, has been long renowned for its clinical functions in bone regeneration and hemostasis [30]. Some studies have suggested that YNB can effectively promote the cell spreading of Caco-2/BBE cells and the committed differentiation of periodontal ligament stem cells (PDLSCs) [31].…”

Section: Discussionmentioning

confidence: 99%

Yunnan Baiyao Conditioned Medium Promotes the Odonto/Osteogenic Capacity of Stem Cells from Apical Papilla via Nuclear Factor Kappa B Signaling Pathway

Pang

Wang

et al. 2019

BioMed Research International

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Yunnan Baiyao is a traditional Chinese herbal remedy that has long been used for its characteristics of wound healing, bone regeneration, and anti-inflammation. However, the effects of Yunnan Baiyao on the odonto/osteogenic differentiation of stem cells from apical papilla (SCAPs) and the potential mechanisms remain unclear. The aim of this study was to investigate the odonto/osteogenic differentiation effects of Yunnan Baiyao on SCAPs and the underlying mechanisms involved. SCAPs were isolated and cocultured with Yunnan Baiyao conditioned media. The proliferation ability was determined by cell counting kit 8 and flow cytometry. The differentiation capacity and the involvement of NF-κB pathway were investigated by alkaline phosphatase assay, alizarin red staining, immunofluorescence assay, real-time RT-PCR, and western blot analyses. Yunnan Baiyao conditioned medium at the concentration of 50 μg/mL upregulated alkaline phosphatase activity, induced more mineralized nodules, and increased the expression of odonto/osteogenic genes/proteins (e.g., OCN/OCN, OPN/OPN, OSX/OSX, RUNX2/RUNX2, ALP/ALP, COL-I/COL-I, DMP1, DSP/DSPP) of SCAPs. In addition, the expression of cytoplasmic phos-IκBα, phos-P65, and nuclear P65 was significantly increased in Yunnan Baiyao conditioned medium treated SCAPs in a time-dependent manner. Conversely, the differentiation of Yunnan Baiyao conditioned medium treated SCAPs was obviously inhibited when these stem cells were cocultured with the specific NF-κB inhibitor BMS345541. Yunnan Baiyao can promote the odonto/osteogenic differentiation of SCAPs via the NF-κB signaling pathway.

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“…In some cases [ 10 ], blood loss exceeded 2,000 mL. The use of tranexamic acid to prevent blood loss in orthognathic surgery [ 11 ] and the use of thromboelastography to predict blood loss [ 12 ] are efforts to reduce complications from bleeding and to minimize the need for blood transfusion. Therefore, as in our study, preparing for intraoperative blood loss by checking preoperative Hb levels and augmenting Hb if necessary is an appropriate method for patients who refuse transfusion.…”

Section: Discussionmentioning

confidence: 99%

How to approach orthognathic surgery in patients who refuse blood transfusion

2020

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Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery.Methods Ten Jehovah’s Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used.Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications.Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah’s Witnesses can be applied to the management of all patients who refuse blood transfusions.

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Prevention of Bleeding in Orthognathic Surgery—A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 57 publications

References 42 publications

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

Yunnan Baiyao Conditioned Medium Promotes the Odonto/Osteogenic Capacity of Stem Cells from Apical Papilla via Nuclear Factor Kappa B Signaling Pathway

How to approach orthognathic surgery in patients who refuse blood transfusion

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