Orthognathic surgery for patients with venous thromboembolism during treatment: Two case reports

Venous thromboembolism (VTE) is a potential life-threatening complication after major surgery. We report two patients in whom VTE occurred during surgical orthodontic treatment for jaw deformities and who underwent orthognathic surgery with VTE recurrence prevention measures. The first patient was a 31-year-old female. She complained of pain in her left lower leg three days after bilateral sagittal split osteotomies and was diagnosed with deep vein thrombosis (DVT) by ultrasonography. Anticoagulant therapy with warfarin potassium was performed for four months after surgery, and the DVT was not observed by ultrasonography. One year after the first surgery, reduction genioplasty was performed with fondaparinux sodium administration as the highest risk case of VTE. The second patient was a 34-year-old male. He was diagnosed with pulmonary embolism (PE) and lower limb DVT during preoperative orthodontic treatment. The patient received anticoagulant therapy with danaparoid sodium and warfarin potassium under hospitalization for two weeks, and anticoagulant therapy with warfarin potassium was continued for six months. Ten months after VTE onset, orthognathic surgeries were performed with heparin calcium administration as the highest risk case of VTE. Patients undergoing orthognathic surgery have a low risk of VTE, but attention should be paid to clinical symptoms such as local swelling, redness, calf muscle tenderness, difficulty in breathing and chest pain after surgery. In addition, if the patient has a history of VTE, anticoagulant therapy after orthognathic surgery must be added to the standard preventive measures for VTE.