Does Perioperative Txa Reduce Post-Operative Edema in Orthognathic Surgery? a Three-Dimensional Morphometric Analysis.
A major cause of patient discomfort after orthognathic surgery is facial swelling. The purpose of this study is to investigate whether perioperative TXA administration reduces post-operative swelling.
Methods/Technique
:This was a retrospective cohort study of consecutive patients who underwent Lefort I osteotomy, bilateral sagittal split osteotomy, and genioplasty on the same day by the senior author (DS) between 2013 and 2019. Patients included in the study had 3D photographs taken at consistent post-operative timepoints, including at first post-op visit (1-2 weeks) and at long term visit (9-14 months). Patients were naturally divided into two groups: those who underwent the procedure before 2017 did not receive TXA, while those after 2017 received a 1g bolus preoperatively and 10mg/kg infusion over 4 hours intra-operatively. Soft tissue volume of the mid- and lower-face region was measured from 3D images using post-processing software (3D VECTRA photosystem, Canfield, Fairfield, NJ). Total post-operative edema volume (TPEV) was defined as the volume change between the first post-op visit and last follow up visit. This volume was compared between TXA and control groups using the Welch two sample t-test.
Results/Complications
:Forty-three patients, including 26 females and 17 males were included in the analysis. The mean TPEV was 54.0±30.1cm3 and 95.2±47.9cm3 in the TXA and control groups, respectively. This was found to be statistically significant (p=0.006).
Conclusion
:This study provides evidence that TXA is effective for reducing edema after orthognathic surgery. This is an important finding, as it may improve the post-operative experience for patients.