Abstract
Orthognathic surgery has recently become a significant element in the field of oral surgery. Owing to factors such as advancements in surgical techniques and the development and improvement of surgical equipment, orthognathic surgery is becoming increasingly safe; however, intraoperative blood loss can still pose a difficult problem in some cases. Therefore, we examined whether tranexamic acid (TXA) can reduce intraoperative blood loss during orthognathic surgery.
The initial group of subjects in this prospective, randomized controlled trial comprised 377 individuals who underwent orthognathic surgery at the Department of Stomatology, Tokyo Metropolitan Ohtsuka Hospital between April 2006 and March 2017. After excluding patients with congenital anomalies (e.g., cleft lip and palate), combined surgery patients, patients with intraoperative complications, reoperation patients, and patients with incomplete intraoperative records, 270 patients were ultimately included in the analysis. Of these 270 patients, 171 underwent sagittal split ramus osteotomy (SSRO) and 99 underwent Le Fort I osteotomy and SSRO (LF I+SSRO).
The subjects were randomly assigned to a TXA group or a control group. The optimal dose of TXA was set at 20mg/kg. Patients who underwent SSRO were classified into two groups: a TXA20 group, which received TXA 20mg/kg immediately prior to surgery, and a control group. Patients who underwent LF I+SSRO were classified into three groups: a TXA20 group, which received a single administration of TXA 20mg/kg immediately prior to maxillary osteotomy; a TXA10+10 group, which received two separate administrations of TXA 10mg/kg immediately prior to maxillary and mandibular osteotomy; and a control group. Groups were compared in terms of age, male/female ratio, body mass index, body surface area, surgical time, total intraoperative blood loss, and intraoperative blood loss per hour of surgery.
Of the patients who underwent SSRO, there was no significant difference in any variable between the two groups. Of the patients who underwent LF I+SSRO, there was no significant difference in total intraoperative blood loss between the TXA20 group and the control group. However, when patients who underwent LF I+SSRO were reclassified based on surgical time, a significant difference was observed in the total intraoperative blood loss in the long surgical time group. In addition, a significant difference was observed in intraoperative blood loss per hour of surgery between the TXA10+10 group and the control group. These results suggest that TXA may be able to reduce intraoperative blood loss during orthognathic surgery.
