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Jang, Kim, Park, Kim, and Kim: Comparative study on the estimated blood loss follwing to orthognathic surgeries
Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(4):272-277.

Published online: 7 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.4.272

Comparative study on the estimated blood loss follwing to orthognathic surgeries

Jin-Hyun Jang, Jin-Woo Kim, Sung-Ho Park, Myung-Rae Kim, Sun-Jong Kim

Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, Korea

Sun-Jong Kim Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University Mokdong Hospital 911-1 Mokdong, Yangcheon-gu, Seoul, 158-050, Korea TEL: +82-2-2650-5041 FAX: +82-2-2650-5764 E-mail: sjsj7777@ewha.ac.kr

Received 27 March 201121 July 2011       Accepted 26 July 2011

Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to compare the estimated blood loss and determine the change in hemoglobin depending on the combination of each orthognathic surgery.

Subjects and Methods

The subjects of this study were patients who underwent orthognathic surgery among those diagnosed with a dentofaical deformity in Mok-Dong hospital, Ewha Womans University from 2002 to 2009. One hundred patients (men - 36, women - 64, mean age of 24.5±4.6) participated in the study and were divided into four groups (group 1 - bilateral sagittal ramus osteotomy [BSSRO], group 2 - BSSRO+Genioplasty, group 3 - Lefort 1+BSSRO+genioplasty, group 4 - anterior segmental osteotomy on maxilla and mandible). A comparative study on the estimated blood loss (EBL), operation time, perioperative changes in hemoglobin was performed using anesthesia records. The results were analyzed statistically using a Mann-Whitney U-test and Spearman’ s Rho test - SPSS 12.0 (SPSS Inc. Chicago, IL, USA).

Results

In group 1 (BSSRO), the mean EBL, operation time and change in hemoglobin was 394.43±52.69 ml, 184±42.33 minutes, and 1.43, respectively, In group 2 (BSSRO+genioplasty), it was 556.32±63.42 ml, 231±37.45 minutes, and 1.80, respectively. In group 3 (Lefort 1+BSSRO+Genioplasty), it was 820.55±105.54 ml, 320±15.41 minutes, and 2.73, respectively. In group 4 (segmental osteotomy), it was 1025.39±160.21 ml, 355±20.10 minutes, and 3.33, respectively. In particular, in group 3, significant differences were observed depending on the method of the orthognathic surgery. The mean EBL in a Lefort 1 osteotomy with advancement was only 687 ml, whereas Lefort 1 osteotomy with canting correction (992 ml), even impaction (764 ml), and posterior nasal spine impaction (100 ml) showed a much higher EBL.

Conclusion

From these results, the EBL and peri-operation hemoglobin increased as treatment plans became more complicated and increasing operation time. Safe orthognathic surgery should be performed by applying proper autologous transfusion plans based on the average EBL of each orthognathic surgery type.

Keywords: Estimated Blood Loss, Orthognathic surgery, Hemoglobin change

REFERENCES

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Fig. 1.
Diagram of Hb change. (POD: postoperative day, BSSRO: bilateral sagittal ramus osteotomy, ASO: anterior segmental osteotomy on maxilla and mandible)
jkaoms-37-272f1.tif
Fig. 2.
Diagram of Hb change followed by date. (G2: group 2, G3: group 3, PreOP-Hb: preoperative hemoglobine, PostOP-Hb: postoperative hemoglobine, POD 1-Hb: postoperative day 1 hemoglobin, POD 3-Hb, POD 4-Hb)
jkaoms-37-272f2.tif
Table 1.
Classification of patients
  Type of surgery No. of patients
G1 BSSRO only 18
G2 BSSRO+genioplasty 15
G3 Lefort 1+BSSRO+genioplasty 61
G4 ASO with Lefort 1+BSSRO 6

(G1: group 1, G2: group 2, G3: group 3, G4: group 4, BSSRO: bilateralsagittal ramus osteotomy, ASO: anterior segmental osteotomy on maxilla and mandible)

Table 2.
Classification of additional maxillary surgery (G3)
Type of surgery (G3) No. of patients
Advance 29
Canting correction 8
Even impaction 8
PNS impaction 16

(G3: group 3, PNS: posterior nasal spine)

Table 3.
OP time according to OP method
OP type OP time (min)
G1. BSSRO only (n=18) 184±42.33
G2. BSSRO+Genioplasty (n=15) 231±37.45
G3. Lefort 1+BSSRO (n=61) 320±15.41
G4. ASO on 2-jaw (n=6) 184±42.33

(OP: operation, G1: group 1, G2: group 2, G3: group 3, G4: group 4, BSSRO: bilateral sagittal ramus osteotomy, ASO: anterior segmental osteotomy on maxilla and mandible)

Table 4.
EBL & hemoglobin changes according to OP method
OP type EBL (mL) EBL/EBV (%) PreOP-Hb (g/dL) PostOP-Hb (g/dL) POD 1-Hb (g/dL) POD 3-Hb (g/dL) POD 4-Hb (g/dL) Hb change (g/dL)
BSSRO only (n=18) 394.43 8.32 13.44 12.01 11.24 − − 1.43
BSSRO+genioplasty (n=15) 556.32 9.44 12.99 11.21 11.7 9.21 (n=7) 11.24 (n=5) 1.78
Lefort 1+BSSRO (n=61) 820.55 17.34 13.28 10.85 9.74 8.65 (n=31) 10.32 (n=14) 2.73
ASO on 2-jaw (n=6) 184 21.32 13.34 10.21 9.25 − − 3.13

(EBL: estimated blood loss, EBV: estimated blood volume, PreOP-Hb: preoperative hemoglobine, PostOP-Hb: postoperative hemoglobine, POD 1-Hb: postoperative day 1 hemoglobin, POD 3-Hb, POD 4-Hb, BSSRO: bilateral sagittal ramus osteotomy, ASO: anterior segmental osteotomy on maxilla and mandible)

Table 5.
EBL changesaccording to OP method in Group 3
OP type (G3) EBL (mL)
Advance 687
Canting correction 992
Even impaction 764
PNS impaction 1,100

EBL: estimated blood loss, OP: operation, PNS: posterior nasal pine)

Table 6.
EBL changes according to OP method in Group 3
Gender EBL (mL) Hb change (g/dL)
Male 643.85 2.04
Female 612.34 2.44

(EBL: estimated blood loss, OP: operation, Hb: hemoglobin)

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