Sugahara Keisuke, Koyama Yu, Koyachi Masahide, Watanabe Akira, Kasahara Kiyohiro, Takano Masayuki, Katakura Akira
Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
Oral Health Science Center, Tokyo Dental College, 2-9-18 Kanda Misaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
Maxillofac Plast Reconstr Surg. 2022 Feb 25;44(1):7. doi: 10.1186/s40902-022-00336-8.
Excessive bleeding is a major intraoperative risk associated with orthognathic surgery. This study aimed to investigate the factors involved in massive bleeding during orthognathic surgeries so that safe surgeries can be performed. Patients (n=213) diagnosed with jaw deformities and treated with bimaxillary orthognathic surgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) in the Department of Oral and Maxillofacial Surgery at the Suidobashi Hospital, Tokyo Dental College between January 2014 and December 2016 were included. Using the patients' medical and operative records, the number of cases according to sex, age at the time of surgery, body mass index (BMI), circulating blood volume, diagnosis of maxillary deformity, direction of maxillary movement, operative duration, incidence of bad split, injury of nasal mucosa, and blood type were analyzed.
The results revealed that BMI, circulating blood volume, nasal mucosal injury, and operative time were associated with the risk of intraoperative massive bleeding in orthognathic surgeries. Chi-square tests and binomial logistic regression analyses showed significant differences in BMI, circulating blood volume, direction of maxillary movement, operative duration, and injury to the nasal mucosa. Operative duration emerged as the most important risk factor. Furthermore, a >4-mm upward migration of the posterior nasal spine predicted the risk of massive bleeding in orthognathic surgery.
The upward movement of the maxilla should be recognized during the preoperative planning stage as a risk factor for intraoperative bleeding, and avoiding damage to the nasal mucosa should be considered a requirement for surgeons to prevent massive bleeding during surgery.
出血过多是正颌外科手术中一项主要的术中风险。本研究旨在调查正颌外科手术中大量出血所涉及的因素，以便能够进行安全的手术。纳入了2014年1月至2016年12月期间在东京齿科大学水道桥医院口腔颌面外科被诊断为颌骨畸形并接受双颌正颌手术（Le Fort I型截骨术和双侧矢状劈开下颌支截骨术）的213例患者。利用患者的医疗和手术记录，分析了按性别、手术时年龄、体重指数（BMI）、循环血容量、上颌骨畸形诊断、上颌骨移动方向、手术持续时间、劈裂不良发生率、鼻黏膜损伤和血型分类的病例数。
结果显示，BMI、循环血容量、鼻黏膜损伤和手术时间与正颌外科手术中术中大量出血的风险相关。卡方检验和二项逻辑回归分析显示，BMI、循环血容量、上颌骨移动方向、手术持续时间和鼻黏膜损伤存在显著差异。手术持续时间是最重要的风险因素。此外，鼻后棘向上移位>4mm预示着正颌外科手术中大量出血的风险。
在上颌骨向上移动应在术前规划阶段被视为术中出血的一个危险因素，并且避免鼻黏膜损伤应被视为外科医生预防手术中大量出血的一项必要措施。
