STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 36

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. 186 Stoma Edu J. 2017;4(3): 184-199 http://www.stomaeduj.com