TRANSFUSION NEED IN ORTHOGNATHIC surgery - A REVIEW
1985; Borstlap et al., 2004; Böttger, 2007; Carry et
al., 2001; Dickerson et al., 1993; Flood et al., 1990;
Garg et al., 2011; Hegtvedt et al., 1987; Landes et al.,
2008; Luz et al., 2004; Martini et al., 2004; Moenning
et al., 1995; Panula et al., 2001; Puelacher et al., 1998;
Teltzrow et al., 2005; Ueki et al., 2005; Umstadt et al.,
2000; Yamashita et al., 2011; Yu et al., 2000). 4,6-8,11-24
These papers were published between1985–2011
and present a total of 9 homologous transfusions
and 14 autologous blood transfusions in 1705
BSSO procedures (advancement and set-back). The
four papers indicating a transfusion have their data
extracted from the period 1981–1996. No patient
after 1996 has needed a transfusion for BSSO (Table
1).
In the paper by Ash and Mercuri (1985), 7 no criterion
was given for transfusion, but observing the range
of blood loss, obviously a maximum loss of 600 mL
as the outer limit of blood loss would not qualify for
transfusion nowadays.
The paper by Flood et al. (1990) 11 mentions a drop in
hemoglobin level from 14.0 (mean) to 12.2 (mean) in
this group; the authors state that some patients had
higher postoperative hemoglobin after transfusion
than preoperative. Again, none of these patients
would qualify for transfusion nowadays. Puelacher
et al. (1998) 19 reinfused autodonated blood in a
high percentage of cases. They do mention that
hemoglobin dropped from 12.7±1.4 (preoperative
after donation) to 11.3±1.3; "only in 7 cases out of 53,
was a blood loss greater than 250 mL documented".
Again, a different transfusion policy would apply
nowadays.
Panula 18 reported 5 homologous transfusions for 434
bilateral sagittal split procedures. The reasons for the
4 cases are not recounted, but one case of BSSO
advancement had an injury in the maxillary artery
during instrumentation of the ascending ramus with
4500 mL blood loss, requiring transfusion. Teltzrow
et al. (2005) 20 reported 15 bleeding complications in
1264 consecutive BSSOs, 7 requiring a transfusion.
Although these authors do not explicitly state whether
it concerned homologous or autologous blood
transfusion, the answer can be found in the paper
by Kramer et al. (2004) 25 from the same department
with Teltzrow as co-author, stating that hemorrhage
as a severe complication (of Le Fort I osteotomies)
was documented when transfusions of erythrocyte
Table 2. Transfusion rate in Le Fort I single jaw osteotomy without concomitant.
Predonation policy Study n/N % 95% CI
No predonation policy Golia et al. (1985) 0/5 0 (0.0;52.2)
Ash and Mercuri (1985) 1/20 5 (0.1;24.9)
Flood et al. (1990) 3/26 11.5 (2.4;30.2)
Dickerson et al. (1993) 0/12 0 (0.0;26.5)
Yu et al. (2000) 0/18 0 (0.0;18.5)
Dolman et al. (2000) 1/23 4.3 (0.1;21.9)
Umstadt et al. (2000) 2/129 1.6 (0.2;5.5)
Carry et al. (2001) 0/16 0 (0.0;20.6)
Panula et al. (2001) 10/65 15.4 (7.6;26.5)
Zelllin et al. (2004) 2/16 12.5 (1.6;38.3)
Landes et al. (2008) 0/4 0 (0.0;60.2)
de Lange et al. (2008) 0/30 0 (0.0;11.6)
Garg (2011) 0/44 0 (0.0;8.0)
19/408 4.5 (1.8; 9.8)
Hegtvedt et al. (1987) 1/25 4 (0.1;20.4)
Moenning et al. (1995) 0/16 0 (0.0;20.6)
Puelacher et al. (1998) 13/23 56.5 (34.5;76.8)
Lenzen et al. (1999) 4/26 15.4 (4.4;34.9)
Böttger S. (2007) 17/28 60.7 (40.6;78.5)
35/118 26.3 (8.5;54.0)
54/526 10.7 (4.6;21.0)
Total
Predonation policy
Total
Overall total
The total and overall total transfusion rates are estimated using a probit-normal model. Where n is the number of patient
and N is the total number of patient.
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