International Journal of Oral and Maxillofacial Surgery
Case ReportDental ImplantsExcessive bleeding in the floor of the mouth after endosseus implant placement: a report of two cases
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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