From the teaching centerVenous Thromboembolism in Oral and Maxillofacial Surgery: A Review of the Literature
Section snippets
Background
Clinical signs of DVT are thought to have been first described by the Indian surgeon Susruta between 600 and 1000 BC, who observed a patient with a “swollen and painful leg, which was difficult to treat.”5 In the 18th and 19th centuries European anatomists Giovanni Battista Morgagni (1761) and later Jean Cruveilhier (1849) discovered clots in the pulmonary vasculature of cadavers that they postulated were related to an inflammatory process.5 Cruveilhier's frequently repeated phrase, “La
Pathophysiology
Venous stasis, aggravated by immobilization, is among the most important risk factors for thrombotic events in hospitalized patients. Stagnation of venous blood creates local hypoxia, which directly activates clotting factors, particularly factor X.8 In the surgical patient, intraoperative venous dilation and distension, due to the effects of anesthesia, are thought to be additional factors contributing to venous stasis.9, 10, 11, 12, 13
Endothelial damage, which activates both intrinsic and
Risk Assessment
Hospitalization is among the most important risk factors for VTE because this is a unique period in which many predisposing conditions may be present (surgery, trauma, intravenous catheters, immobilization, pregnancy, chronic conditions). Rates of VTE for hospitalized surgical patients are up to 150 times higher compared with patients undergoing same-day surgery.9, 11 The American College of Chest Physicians has published comprehensive guidelines regarding VTE risk stratification and
Diagnosis
Although 30% to 50% of DVT are estimated to be asymptomatic, clinical signs and symptoms are the first step in making a diagnosis.30 Signs include unilateral lower extremity leg edema; a hard, band-like palpable vein; localized tenderness with erythema; loss of ipsilateral peripheral pulses (may be present with a large DVT); fever; malaise; and warmth adjacent to the site of pain. Homan's sign (pain on dorsiflexion of the ankle), once considered a helpful clinical test, has low sensitivity and
Thromboprophylaxis
A variety of prophylactic mechanical and pharmacologic measures have been used to reduce VTE risk. Mechanical compression devices include graded elastic compression stockings, intermittent pneumatic compression devices, and foot pumps. Pneumatic compression devices apply intermittent, sequential pressure to the calves, thighs, or feet by means of disposable sleeves connected to a pump via plastic hoses. Increased venous blood flow and stimulation of fibrinolytic mediators are thought to be the
Incidence in Oral and Maxillofacial Surgery and Other Head and Neck Specialties
Limited data exist about VTE risk in patients undergoing oral and maxillofacial surgery; however, available studies have shown that VTE risk is exceptionally low with an estimated range of 0.15% to 1.6%.43, 44, 45, 46 Two postal surveys conducted in the UK found a low incidence of VTE, with malignancy or trauma as the primary risk factors in those patients who experienced thrombotic events.18 Only 67% of the oral maxillofacial surgeons polled in one of these surveys admitted to routinely
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Cited by (16)
Development and validation of a nomogram for identifying venous thromboembolism following oral and maxillofacial oncological surgery with simultaneous reconstruction
2024, European Journal of Surgical OncologyOrthognathic Surgery-Induced Fibrinolytic Shutdown Is Amplified by Tranexamic Acid
2020, Journal of Oral and Maxillofacial SurgeryAn Unusual Case of Deep Vein Thrombosis After Orthognathic Surgery: A Case Report and Review of the Literature
2018, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Thus, oral and maxillofacial surgeons must thoroughly assess their patients' risk factors for VTE to take proper preoperative preventive measures. According to the National Heart, Lung, and Blood Institute, symptoms of DVT might occur in only approximately half of patients.4 Clinical signs and symptoms that contribute to the diagnosis of DVT include pain, swelling, warmth, tenderness, and erythema of the leg, calf, or arm skin in addition to muscle rigidity, lymphangitis, fever, and malaise.4,5,12
Incidence of symptomatic venous thromboembolism in oncological oral and maxillofacial operations: Retrospective analysis
2015, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :According to current reports, patients who have oncological oral and maxillofacial operations are categorised as being at high risk of VTE. They often have several serious risk factors, which include prolonged immobilisation, presence of active cancer, and advanced age.11–13 We know of few studies that have analysed the risk and incidence of VTE in patients who have oral and maxillofacial operations for cancer.
Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: A retrospective cohort study of 4127 patients
2014, British Journal of Oral and Maxillofacial SurgeryCitation Excerpt :To compare the risks of thromboembolism in orthopaedic, and maxillofacial orthopaedic, surgery might seem far-fetched. Its pathophysiology, which is known as Virchow's triad, consists of venous stasis, endothelial damage, and hypercoagulability, and these are to some extent present in both groups of patients.16 Orthognathic surgery has been modified and improved in the last decades.
Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis
2012, International Journal of Oral and Maxillofacial SurgeryCitation Excerpt :In this analysis patients with maxillofacial trauma were excluded.9 In a recent review, Williams investigated the incidence of VTE in patients with only orthognatic and reconstructive maxillofacial procedures.17 To the authors’ knowledge, there is no information on the incidence and risk of VTE in patients with maxillofacial trauma.