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"Bloodless" Oral and Maxillofacial Surgery Puts Patients at Ease

by Sheila Smith Noonan

The fear of pain keeps some people from scheduling a routine dental appointment. But for others facing more invasive procedures, such as oral and maxillofacial surgery, it may be the fear of receiving a blood transfusion that stands between them and proper treatment.

Granted, the majority of oral and maxillofacial surgeries generate very little blood loss. But for certain procedures, such as orthognathic surgery, maxillofacial reconstructive surgery, and those related to craniofacial trauma or head and neck cancer, there is a greater possibility of higher blood loss.

Even the remote possibility of transfusion is enough to deter Jehovah's Witnesses, who refuse to receive whole blood, red or white cells, platelets, or blood plasma, for religious reasons, or people who simply fear a blood transfusion. The modern blood banks at hospitals are monitored closely and have a very low possibility of transmission of disease or incompatibility. Nevertheless, some people still feel uneasy about blood transfusion.

For these patients, there are options that don't compromise treatment and, in fact, are good surgical techniques, according to Dr. Vincent Ziccardi, director of the OMS residency program at New Jersey Dental School. "Probably the most common technique we use is hypotensive anesthesia, which involves a controlled lowering of the patient's mean arterial pressure during surgery through various agents," he says. In addition to reducing blood loss, the technique can also shorten operating time.

There are other strategies that can be used. Iron therapies help the body more quickly produce red blood cells, and hemodilution with crystalloid IV solutions increases blood volume. The latter is a technique where a unit of the patient's blood is removed in the operating room and replaced with crystalloid. The blood is returned to the patient at the completion of surgery while in the OR. The use of lasers for some specific procedures can also minimize blood loss. Many of these techniques, such as hemodilution, can be done in combination with other therapies, Dr. Ziccardi says. And for some patients, autologous donation, where they would receive their own blood, brings peace of mind.

What many patients who choose bloodless techniques want is not only adherence to their preference, but respect for it. The University Center for Bloodless Surgery & Medicine at University Hospital has earned a reputation for both. From pediatric tubes and microsampling for pre-op testing to the use of color-coded charts, wristbands, and bed signage, the Center is at the
vanguard of this relatively new medical specialty. Coronary bypass and brain surgery, among other highly specialized procedures, have successfully been performed at University Hospital using bloodless techniques.

Dr. Ziccardi and two other NJDS faculty members­Dr. Kathy Banks, clinical assistant professor of OMS, and Dr. Stephen Cantrell, assistant professor of OMS­are affiliated with the Center, which is among the few hospital-based programs in the country that practice this state-of-the-art approach to medical and surgical care.

Transfusion-free oral and maxillofacial surgery may seem like the gold standard of treatment to those providing it. But for those folks on the receiving end, it's answered prayer.


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