Maxillary distraction osteogenesis in the management of cleft lip and palate: report of 2 cases

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 ill 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, peri-operative 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 ㎖, 184±4233 minutes, and 1.43, respectively, In group 2 (BSSRO+genioplasty), it was 55632±63.42 ㎖, 231±37.45 minutes, and 1.80, respectively. In group 3 (Lefort 1+BSSRO+Genioplasty), it was 820.55±105.54 ㎖, 320±15.41 minutes, and 2.73, respectively. In group 4 (segmental osteotomy), it was 102539±160.21 ㎖, 355±20.10 minutes, and 333, 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 ㎖, whereas Lefort 1 osteotomy with canting correction (992 ㎖), even impaction (764 ㎖), and posterior nasal spine impaction (100 ㎖) 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.