Case Report
Dental Implants
Excessive bleeding in the floor of the mouth after endosseus implant placement: a report of two cases

https://doi.org/10.1016/j.ijom.2009.07.062Get rights and content

Abstract

Placement of dental implants in the interforaminal region of the edentulous mandible is considered a safe and routine surgical procedure. Hemorrhage in the floor of the mouth has been reported as a rare, potentially life-threatening complication related to the placement of implants in this region. In this case report the authors present an immediate and a delayed case of massive bleeding in the floor of the mouth after implant placement. This highly vascularized region is vulnerable and bleeding can be induced easily by instrumentation, causing a vascular trauma, usually by perforation of lingual periostium. In almost all cases the expanding hematoma formation starts during surgery. The effect of the vasoconstrictive agent in the local anesthesic combined with an injury of the lingual arterio-venous plexus can result in delayed swelling, causing respiratory distress through obstruction of the upper airways.

Section snippets

Case 1

A 76-year-old woman with an atrophic edentulous mandible was referred. During interforaminal implant placement under local anesthesia, performed by her dentist, bleeding in the floor of the mouth resulted in progressive swelling of her tongue. The dentist immediately called for medical support. The patient had no history of bleeding disorders and did not use any anticoagulant medication. 15 min later the patient presented in the hospital emergency room with mild breathing difficulty. The dentist

Case 2

A 62-year-old man with an edentulous mandible was referred for placement of dental implants. The patient had no history of bleeding and did not take anticoagulant medication. Two implants were positioned in the interforaminal region and there were no problems during surgery. No lingual perforation was noticed. 7 hours after surgery, the patient contacted the on-call maxillofacial surgeon with respiratory distress and swelling of the floor of the mouth.

At presentation in the emergency room, his

Discussion

The first patient developed an immediate swelling of the floor of the mouth, whereas the second patient showed a delayed hemorrhage. Immediate hemorrhaging has been described previously2, 5, 6, 8, 9, 10, 11, 13, 16, 19, 20. Late hemorrhaging is seldom reported3, 12, 15 (Table 1). An explanation for the delayed bleeding may be vasoconstriction caused by the local anesthesia, which can mask trauma of the lingual arterio-venous plexus. The initial hemostasis of the constricted artery, which should

Treatment considerations

Airway security is the priority in these patients2, 3, 4, 5, 6, 10, 15, 17, 18, 19, 20. In cases of severe hemorrhage, it is almost impossible to visualize the anatomy in the affected area and retraction of the artery after laceration makes ligation difficult or impossible. In most cases, after securing the airway by intubation or tracheotomy, hemostasis will result from compression by the expanding hematoma and diminish the bleeding.

If there is a need for surgical intervention for controlling

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

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