Prevalence of postoperative secondary bleeding and its relationship with intraoperative massive bleeding in patients undergoing orthognathic surgery

Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies

Study Design

This is a literature review with 3 case studies.

Objective

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.

Methods

A literature search of PubMed was conducted and 28 cases from 17 studies were assessed.

Results

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.

Conclusions

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.

Dental discoloration following Le Fort 1 osteotomy, a systematic review

INTRODUCTION

This study was conducted to review current knowledge concerning factor and how to proceed with dental discoloration after Le Fort 1 osteotomy (LF1O).

MATERIAL & METHODS

A systematic search of the literature was performed in PubMed/Medline and Cochrane library until December 1, 2020 using the following key words: "dental discoloration and osteotomy", "dental discoloration and Le Fort", "dental discoloration and orthognathic", "dental discoloration and surgery", "tooth discoloration and osteotomy", "tooth discoloration and Le Fort", "tooth discoloration and orthognathic", "tooth discoloration and surgery".

RESULTS

705 studies were located by initial screening; 232 were duplicate, 468 did not meet the eligibility criteria, leaving 5 studies. The post-operative follow-up period of the included studies ranged from 6 months to 2 years.

CONCLUSION

The present revue found dental discoloration can occur after LF1O in 3.56% of the cases. The follow-up before treatment should be around one years. If the discoloration persisted and pulpal sensibility test is negative, the tooth should be treated. If the pulpal sensibility test is positive, follow-up should be carry on.