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MAXILLOFACIAL SURGERY BLOODLOSS AND TRANSFUSION NEED IN ORTHOGNATHIC SURGERY: REVIEW OF LITERATURE Constantinus Politis 1a* , Jimoh Olubanwo Agbaje 1b , Ivo Lambrichts 2c OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium and Depart- ment 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 BDS, DMD, FMCDS, MMI, PhD c DDS, PhD, Professor a b ABSTRACT DOI: 10.25241/stomaeduj.2018.5(1).art.5 Background: Blood loss during orthognathic surgery has gained renewed interest due to the omission of surgical final splints in bimaxillary surgery, which increased operative time, while orthognathic surgery is increasingly indicated for the treatment of the obstructive sleep apnea syndrome (OSAS). OSAS subjects are usually older with more medical comorbidity which requires blood transfusion. Objective: To review (reported) blood loss and transfusion practice in orthognathic surgery in the literature published between 1976 and 2012 and to compare these data with more recent developments. The relationship between the duration of the surgery and the related blood loss and/or transfusion was examined. Data Sources: The 1976-2012 orthognathic literature was searched to determine the relationship between the duration of the surgery and the related blood loss and/or transfusion. Study Selection: Articles containing clear information on the operation time, blood loss, transfusion, and orthognathic surgery were included. Data Extraction: Information on the 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, resulting in a 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 Blood loss during orthognathic surgery has gained renewed interest for several reasons. A first reason is found in a recent school of thought that advocates the omission of surgical final splints in bimaxillary surgery but insists on the perioperative achievement of an excellent interdigitation, which in many cases can be achieved only by multisegmenting the Le Fort I osteotomy at the cost of increased operative time. Because orthognathic surgery is increasingly used to enhance facial aesthetics, many concomitant procedures have been reported [1], all of them influencing the duration of the operative procedure and blood loss. Orthognathic patients used to be generally young adults without major comorbidities. That scope is changing because orthognathic surgery is increasingly indicated for the treatment of the obstructive sleep apnea syndrome (OSAS). OSAS subjects undergoing maxillomandibular advancement surgery are likely older with more medical comorbidity [2], influencing the limit below which blood transfusion is indicated. Blood loss during surgery requiring blood transfusion is viewed as an important operative complication, designated as a grade II complication in the Clavien-Dindo complication classification system, which is becoming widely accepted for surgical complications, even in oral and maxillofacial surgery [3]. 44 OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license. Peer-Reviewed Article Citation: Politis C, Agbaje JO, Lambrichts I. Bloodloss and transfusion need in orthognathic surgery: review of literature. Stoma Edu J. 2018;5(1):44-51. Academic Editor: Heinz Kniha, DDS, MD, PhD, Associate Professor, Ludwig- Maximilians- München University, München, Germany Received: January 03, 2018 Revised: February 05, 2018 Acccepted: February 23, 2018 Published: February 26, 2018 *Corresponding author: Professor Constantinus Politis, MD, DDS, MHA, MM, PhD, Department of Oral & Maxil- lofacial Surgery, University Hospitals of Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium, Telephone: [phone], Fax: [phone], e-mail: [email protected] Copyright: © 2018 the Editorial Coun- cil for the Stomatology Edu Journal. Although a Cochrane review recommends adherence to a restrictive transfusion strategy (7 to 8 g/dL) [4] in hospitalized stable patients, a remarkable tendency to preoperative autologous blood donation is seen even in surgical procedures – such as single-jaw SSO – that nowadays are considered low risk for blood loss [5]. The aim of the present contribution is to review (reported) blood loss and transfusion practice in orthognathic surgery in the literature published between 1976 and 2012. The relationship between the duration of the surgery and the related blood loss and/or transfusion was examined. 2. Methods 2.1. Research questions The relevant clinical questions that should be answered are as follows: • Is the operation time a predictor for blood loss and/ or blood transfusion? • Are concomitant procedures (segmentation, genioplasty, rhinoplasty, iliac crest grafts) predictors for blood loss and/or blood transfusion? • Is the practice of preoperative autologous blood donation a predictor for blood loss and/or blood transfusion? • What are the measures taken to minimise blood Stoma Edu J. 2018;5(1): 44-51 http://www.stomaeduj.com