Girard Alisa, Lopez Christopher D, Chen Jonlin, Perrault David, Desai Nikhil, Bruckman Karl C, Bartlett Scott P, Yang Robin
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Plastic Surgery, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA.
Craniomaxillofac Trauma Reconstr. 2022 Jun;15(2):147-163. doi: 10.1177/19433875211008086. Epub 2021 Apr 8.
This is a literature review with 3 case studies.
Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to 1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, 2) identify management approaches, and 3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis.
A literature search of PubMed was conducted and 28 cases from 17 studies were assessed.
Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases.
As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability.
这是一项包含3个病例研究的文献综述。
术中及术后出血是正颌外科手术最常见的并发症，有可能危及生命。严重术后鼻出血的罕见性导致文献中对这些病例的描述有限。本研究的目的是：1）区分文献中正颌外科手术后鼻出血的各种表现；2）确定管理方法；3）综合制定一种治疗算法，以指导未来对术后鼻出血的管理。
对PubMed进行文献检索，并评估了17项研究中的28个病例。
第一周内出血可能提示孤立性鼻出血，通常通过局部填塞解决。一半的病例归因于假性动脉瘤破裂（n = 14），鼻出血发生时间从术后第6天至第9周不等。大多数病例（n = 17）使用了血管造影，通常作为主要的成像方式（n = 11）。鼻内镜检查是一种侵入性较小且有效的血管造影替代方法，可用于栓塞。3例使用了近端血管结扎，但不推荐，因为侧支血管可能重新建立通过缺损的血流并导致再次出血。4例描述了重复上颌骨向下折断并进行手术探查。
正如我们的管理算法中所概述的，鼻填塞和压迫后应进行局部电灼或血管成像。血管造影栓塞是诊断和管理的首选方法，而手术干预则保留用于栓塞失败或无法进行栓塞的病例。
