Table 3. Transfusion rate in Le Fort I single jaw osteotomy without concomitant procedures: predonation policy versus no
predonation policy.
Le Fort I single-jaw osteotomy without additional complex procedures (segmentation or additional procedures)
Patients (n)
Predonation policy
118
Patients (n) Type of blood used in
with transfusion transfusion
35 Autologous including 1
% transfused
patients
24%
autologous+ homologous
No predonation policy 408 19 Homologous 6,6%
Total 526 54 - 11,2%
concentrates from foreign donors were required
after the autologous blood donation already had
been given. In our own series of 1281 consecutive
bilateral sagittal split procedures, spanning a period
from 1989–2012, no case of transfusion need was
seen correlated to the SSO. Except for excessive loss
due to unforeseen vascular injury during BSSO, no
transfusion need is to be expected in BSSO surgery,
even if the surgery is of a long duration. No cross-
match or predonation policy is required.
3.1.2. Le Fort I single-jaw surgery without additional
complex procedures
Considering single-jaw Le Fort I osteotomies without
segmentation or explicit statement of additional
procedures, several articles fulfilled this criterion
(Ash and Mercuri, 1985; Böttger, 2007; Carry et al.,
2001; de Lange et al., 2008; Dickerson et al., 1993;
Dolman et al., 2000; Flood et al., 1990; Garg et
al., 2011; Golia et al., 1985; Hegtvedt et al., 1987;
Kok-Leng Yeow and Por, 2008; Landes et al., 2008;
Lenzen et al., 1999; Martini et al., 2004; Moenning
et al., 1995; Mohorn et al., 1995; Panula et al.,
2001; Praveen et al., 2001; Puelacher et al., 1998;
Umstadt et al., 2000; Yu et al., 2000; Zellin et al.,
2004) 4,7,9,10-14,16-19,22,24,26-33 (Table 2).
The papers by Kok-Leng Yeow and Por (2008), 29
Praveen et al. (2001), 32 and Martini et al. (2004) 16 did
not have a transfusion rate for this subgroup and were
discarded. The study by Mohorn et al. (1995) 31 had
a defined group of Le Fort I osteotomies, but these
were retrieved from other authors, so this report was
also discarded. The paper by Umstadt et al. (2000) 22
was classified as a no-predonation policy because
not one single patient received any autologous
blood. If transfusions were needed, homologous
blood was given.
In the paper by Puelacher one patient received both
autologous blood and additional homologous units.
as seen in Table 3. In all other cases of autologous
transfusion in Table 3, the available autologous units
were sufficient.
A statistical analysis was done in the SAS program,
with 95% exact confidence intervals calculated for
the individual studies. The overall transfusion rates
and corresponding 95% confidence intervals were
statistically estimated using a probit-normal model.
A significant difference between predonation and no
predonation policy could be shown (p=0.0166). The
intra-study correlation was found to be significant.
The intra-study correlation in the no predonation
policy group was 0.06 (p=0.2896). The intra-study
Stomatology Edu Journal
correlation in the predonation policy group was 0.31
(p=0.0662). The statement can be made that when
predonation of autologous blood has occurred,
the risk of being transfused is higher and does
not exclude the need for additional homologous
transfusion in case the transfusion need exceeds the
available units of autodonated blood.
Figure 1 shows an error-bar chart using the SAS
statistical program, and displays the % of transfusion
as a dot and its associated confidence interval as a
horizontal line. This effectively communicates the
precision associated with each effect size and the
general pattern of results.
The comparison of the available mean blood losses
between the predonation and no-predonation policy
groups supports the statement that predonation in
single Le Fort I surgery without additional procedures
results in more mean blood loss measured in the
predonation group than in the other group (Table 4).
As far as hypotension is concerned, the entire range
of blood pressure control is found without relation
to blood loss (normotension, mild controlled
hypotension, moderate controlled hypotension,
deep controlled hypotension). The liberal reinfusion
of autologous blood in these series needs to be met
with skepticism. However, a need remains of about
4.5 % requiring a blood transfusion in single-jaw
Le Fort I procedures without additional complex
procedures in the no-predonation policy group,
according to a probit-normal statistical model.
One should be careful with percent values of blood
transfusion in the literature. Kramer et al. (2004) 32
indicate a transfusion need of 1.1% in 1000 Le Fort
I operations (11 patients transfused), prospectively
studied. It should be noted that the 1.1% occurred
in bimaxillary operations; the authors explicitly
state that hemorrhage after Le Fort I osteotomy was
documented only when transfusions of erythrocyte
concentrates from foreign donors were required
after autologous blood donation already had been
given. The total transfusion need in this large series
of Le Fort I cannot be recovered.
3.1.3. Le Fort I single-jaw surgery with additional
procedures
A total of 211 Le Fort I single-jaw surgical cases
qualify as ‘complex’, either because they concerned
cleft patients or because of multi-piece segmentation
with an additional bone-grafting, mostly an iliac
crest graft. Of interest, the recent literature does not
provide many papers describing performance of Le
Fort I single-jaw surgery: Schaberg et al., 1976; 34 Ash
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