STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 34

MAXILLOFACIAL SURGERY TRANSFUSION NEED IN ORTHOGNATHIC SURGERY - A REVIEW Constantinus Politis 1a* , Ivo Lambrichts 2b , Jimoh Olubanwo Agbaje 1c OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, BE-3000 Leuven, Belgium 2 Faculty of Medicine, Hasselt University, Diepenbeek, Belgium; Biomedical Research Institute, Laboratory of Morphology, Hasselt University, Campus Diepenbeek, BE-3590 Diepenbeek, Belgium 1 MD, DDS, MHA, MM, PhD, Professor DDS, PhD, Professor c BDS, DMD, FMCDS, MMI, PhD a b Received : April 03, 2017 Revised: May 05, 2017 Accepted: August 14, 2017 Published: August 16, 2017 Academic Editor: Nardi Casap-Caspi, DMD, MD, PhD, Professor and Head, Hebrew University Hadassah Jerusalem, Jerusalem, Israel Cite this article: Politis C, Lambrichts I, Agbaje JO. Transfusion need in orthognathic surgery - a review. Stoma Edu J. 2017;4(3):184-199. Abstract DOI: 10.25241/stomaeduj.2017.4(3).art.4 Background: Excessive blood loss is the most frequently encountered perioperative problem in maxillary surgery, sometimes necessitating blood transfusion. Objective: The aim of the present contribution is to review the relationship between different types of orthognathic procedures and the related blood loss in the literature published between 1976 and 2012. Data Sources: The orthognathic literature was searched from 1976 to 2012 to determine the relationship between different types of orthognathic procedures and the related blood loss, duration of surgery and/or transfusion need. Study Selection: articles containing clear information on allocation of operation time AND/OR blood loss AND/OR transfusion were included. Data Extraction: information on operation time, blood loss, transfusion, and orthognathic surgery was extracted. Data Synthesis: Different descriptions of procedures and techniques are grouped together in a concise and coherent way, this result in number of categories per label, using this grouping various targeted questions are exploited and answered. Keywords: orthognathic surgery, blood loss, operation time, blood transfusion. 1. Introduction Excessive blood loss is the most frequently encountered perioperative problem in maxillary surgery, sometimes necessitating blood transfusion according to Mahy et al. 1 Blood transfusion in itself can lead to complications, such as the transmission of disease or graft-versus- host reactions. Piñeiro-Aguilar et al. (2011), 2 in a recent systematic review, concluded that intraoperative bleeding observed in patients undergoing Le Fort I and mandibular ramus osteotomies, alone or combined, has generally been less than the limits set to determine the need for a blood transfusion (indicated in healthy adults when hemoglobin is less than 7 g/dL). However, they state bleeding can sometimes reach or surpass the threshold limits for a blood transfusion, and this event should be anticipated by reserving blood at a blood bank or by preparing an autotransfusion. Piñeiro-Aguilar et al’s paper was criticised by Dodson (2011) 3 because there was no clear, clinically directed, specific clinical question or challenge to address, resulting in clinically uninformative results. Also, the review of Piñeiro-Aguilar et al. (2011) 2 failed to differentiate among the different orthognathic procedures, and all procedures (single-jaw Bilateral Sagittal Split Osteotomy (BSSO), single-jaw Le Fort I, bimaxillary procedures) were treated in the study as a single entity. The aim of the present contribution is to review the relationship between different types of orthognathic procedures and the related blood loss in the literature published between 1976 and 2012. 2. Methods 2.1. Literature review: selection criteria The following entries: Blood loss and orthognathic, Transfusion and orthognathic, Hypotension and orthognathic and Blood transfusion and orthognathic surgery that were introduced in PubMed, Scopus and LIMO. No limits were set for language, year, field. A manual search for articles containing information on operation time, blood loss, transfusion, and orthognathic surgery was performed in the following journals until 1976: - British Journal of Oral and Maxillofacial Surgery *Corresponding author: Professor Constantinus Politis, MD, DDS, MHA, MM, PhD, Department of Oral & Maxillofacial Surgery, University Hospitals of Leuven, Kapucijnenvoer 33, BE-3000 Leuven, Belgium Phone: +32 (0) 16.341780, Fax: +32 (0) 16 3 32437, e-mail: c.politis@village.uunet.be 184 Stoma Edu J. 2017;4(3): 184-199 http://www.stomaeduj.com