Aliases:
Bimaxillary osteotomy
Bi-maxillary osteotomy
Bi maxillary osteotomy

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Considerations as for prolonged surgery

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Animation of mandibular advancement procedure.

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Arterial blood pressure monitoring will be useful if a maxillary procedure is being performed.
These patients are at risk of significant blood loss and will require a period of induced hypotension.

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Temperature monitoring

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If the patient is at risk of difficult mask ventilation or laryngoscopy, consider inserting a nasal reinforced ETT using an awake nasal fiberoptic intubation technique

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Insert throat pack to minimise the entry of blood into the trachea.

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Nasal RAE inserted asleep if patient is not at high risk of difficult ventilation

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Spraying cords and trachea with local anesthetic may help to minimise coughing on emergence
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Patient may be positioned head up 15-30 degrees to minimise venous pressure at the surgical site.
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Aim to avoid post-operative nausea and vomiting as this risks disrupting the surgical site. refl.in/ia

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Surgeons will perform local anesthetic infiltration and nerve blocks at commencement of the case, so pain should not be severe.

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Consider maintaining a low normal blood pressure to minimise bleeding. The tissues of the skull and face are quite vascular. refl.in/ia

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Aim for a limited period of hypotension aiming for MAP in the range of 60-70mmHg if patient is young and otherwise fit.
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Cross match blood if undergoing a maxillary procedure. Maxillary surgery usually results in greater blood loss than mandibular procedures.

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Forced air warming blanket and temperature probe

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Aim for an awake extubation. A fully awake patient minimises the risk of laryngospasm and airway obstruction in the patient in which airway swelling will make mask ventilation and reintubation difficult.

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