Intraoral Hemorrhage Research Articles

Torrential intraoral bleed in a mandibular arteriovenous malformation: Resuscitation under nonoperating room settings

Arteriovenous malformation (AVM) of the head and neck, though rare, can present significant clinical challenges, particularly during dental procedures. This case report details the acute management of a 7-year-old girl with an AVM in the right mandible, with sudden, severe, torrential intraoral hemorrhage during an angioembolization procedure, necessitating immediate airway management and hemodynamic stabilization in a nonoperating room anesthesia (NORA) setting. Persistent bleeding led to a multidisciplinary intervention, including external carotid artery ligation and right hemimandibulectomy, achieving hemostasis. The case underscores the importance of meticulous planning, readiness with resuscitation and airway management equipment, and coordinated efforts among anesthesia and surgical teams in NORA settings to manage such critical situations effectively.

A "Tie-Over" Hemostatic Approach in Emergency Department: An Alternative Option for Recurrent Episodes of Postoperative Intraoral Hemorrhage.

This case series aimed to describe a hemostatic technique that has been applied in patients admitted to emergency department (ED) of a tertiary hospital due to recurrent episodes of intraoral hemorrhage (IOH) after various dentoalveolar operations. The "tie-over" approach involved the intraoral use of Xeroform® gauze (as compressive bolster dressing) and the oral rinsingwitha liquid mixture of hemostatic agents. Between February 1, 2014, and July 31, 2017, we retrospectively reviewed the medical data and records of patients in ED who chiefly complained about IOH. The inclusion criteria were cases secondary to dentoalveolar surgeries that have been exclusively treated by tie-over bolster approach. Data such as frequency and severity of hemorrhage episodes, pain, and discomfort were assessed pre- and postoperatively. The presented technique was applied in 23 patients, but 20 of them complied with follow-up evaluation. The mean age of those patients was 60.57years (15-82years) with a mean follow-up time of 5.05days. Eighteen patients were taking antithrombotic medications, either per os (oral antiplatelets and anticoagulants-OAA group) or subcutaneously (heparin group). One patient from OAA group and 2 from heparin group experienced in total 4 bleeding events postoperatively. Three of those events were recorded as minimal (oozing) and did not last over 20min. All the patients declared satisfaction about the non-bleeding oral status. In addition to its compelling outcomes, we advocate that this approach conferred physiological benefits on patients who visited ED with symptoms of anxiety and malaise, secondary to multiple, lasting, or uncontrolled episodes of IOH related to extensive surgical trauma. The presence of the gauze intraorally was short-term and created minimal discomfort.

Aneurysm-related disseminated intravascular coagulation successfully treated by endovascular repair.

Aortic abdominal aneurysm (AAA) is an uncommon etiology of disseminated intravascular coagulation (DIC). The authors report a case of an 81-year-old male patient who presented with hematuria, intraoral hemorrhage, melaenas and ecchymosis of the lower back and of the abdominal wall, after being medicated with etoricoxib for a back pain. During the study, an abdominal aortic aneurysm, which prolonged to the left common and internal iliac artery, was discovered. The diagnosis of AAA induced DIC was made. After endovascular aneurysm repair (EVAR), the patient’s hemorrhagic manifestations disappeared and the laboratory findings normalized. In conclusion, the state-of-the-art treatment of DIC is the elimination of the underlying disease; in this case, EVAR was proven to be effective in treating the aortic aneurysm and the AAA-related DIC.

Superselective Microcatheter Embolization of Hemorrhage after Buccal Lipectomy

Superselective microcatheter angiography and embolization has been shown to be an effective modality for prompt treatment of bleeding from traumatic facial injury and refractory epistaxis when local methods fail to achieve hemostasis. It obviates the need for further surgical exploration and provides precise diagnostic and therapeutic modalities in a minimally invasive manner. Despite this successful profile, its use in treatment of hemorrhagic complications after facial aesthetic surgery is underreported. This report is a unique case of life-threatening hemorrhage after buccal fat pad lipectomy that was successfully treated with superselective microcatheter embolization of internal maxillary artery branches. A 31-year-old male was transferred to our emergency room from an outside facility with an active intraoral hemorrhage after a buccal lipectomy in which severe bleeding was encountered deep within the buccal space that persisted despite further attempts at surgical exploration. On arrival to the emergency room, the patient demonstrated signs of significant blood loss and had intraoral packing in place tamponading further hemorrhage. The patient underwent resuscitation and stabilization with endotracheal intubation for airway protection and was sent emergently to the angiography suite. Superselective angiography was used to study branches of the internal maxillary artery. Superselective embolization using microspheres was then performed on target vessels to control the bleeding. The surgical packing was then removed with no evidence of active bleeding. The patient was transferred to the surgical intensive care unit for further monitoring and was discharged the following day in stable condition. In the case of refractory surgical measures, superselective microcatheter angiography and embolization provides an alternative to both precisely localize and control severe small-artery bleeding. This may be ideal in cases that otherwise would require extensive dissection and in regions of complex anatomy, both of which can compromise aesthetic outcomes. We demonstrated the use of this method in a case of refractory bleeding after facial lipectomy. The expanding role of superselective angiography and specifically designed embolic agents may play an invaluable role in treatment of arterial injury after aesthetic surgery when local methods fail. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

Spontaneous Intraoral Hemorrhage as Manifestation of Thoracoabdominal Aortic Aneurysm-Associated Disseminated Intravascular Coagulation: Case Report and Review

Intraoral bleeding from the gingiva or alveolar mucosa is a common symptom in dental and oral surgery outpatients. The bleeding is relatively easy to control with professional dental treatment, because it is almost always from local causes, such as inflammation or application of extreme external force to the mucosa. Occasionally, persistent or intermittent hemorrhage refractory to treatment indicates a general hemostatic disturbance, including coagulation factor deficiencies, fibrinolytic defects, and platelet or vascular disorders.

Clinical Recommendations for Avoiding and Managing Surgical Complications Associated With Implant Dentistry: A Review

Proposing to place endosseous implants is an integral facet of dental treatment plans. Their insertion is usually associated with a low incidence of untoward events. However, despite careful planning, surgical complications can arise: infection, intraoral hemorrhage, wound dehiscence, postoperative pain, lack of primary implant stability, inadvertent penetration into the maxillary sinus or nasal fossa, sinus lift sequelae, neurosensory disturbances, injuries to adjacent teeth, tissue emphysema, and aspiration, or ingestion of surgical instruments. This article addresses some surgical complications associated with dental implant placement and discusses how to avoid and manage them when they occur.

Management of penetrating injuries to carotid artery.

The diagnosis and management of penetrating injuries to the cervical carotid arteries continue to be controversial. Most patients with stab or gunshot wounds to the common or internal carotid artery in cervical zone II (sternal notch to angle of mandible) are symptomatic with external or intraoral hemorrhage, a rapidly expanding hematoma, evidence of a carotid-jugular arteriovenous fistula at an obvious site, or loss of the carotid pulse with a neurologic deficit. Immediate airway control and arterial repair are indicated in such patients. Other patients present with stab or gunshot wounds with proximity only to the carotid sheath, a stable hematoma, unknown level of a carotid-jugular arteriovenous fistula, or loss of the carotid pulse without a neurologic deficit. Diagnostic options in this latter group include duplex ultrasound, color duplex imaging, and standard arteriography, while the role of CT or MRI angiography in evaluating patients with penetrating cervical wounds is unclear at this time. Certain arterial injuries discovered on diagnostic tests are currently managed with observation, endovascular stenting (for intimal or wall irregularities), and arteriographic embolization (for small pseudoaneurysms or high carotid-jugular fistulas). Operative repairs for injuries in zone II are performed through an oblique cervical incision and include all the options used with peripheral vascular injuries. Patients with penetrating cervical wounds, preoperative neurologic deficits, and immediate transport to the trauma center should have repair rather than ligation of the injured carotid artery. When the patient is truly comatose with a Glasgow Coma Scale score < 8, an unsatisfactory neurologic outcome is likely with either arterial repair or ligation. Injuries to the extracranial internal carotid artery in cervical zone III (above the angle of the mandible) may require innovative approaches to control hemorrhage and then maintain flow to the ipsilateral cerebral cortex.

Extraoral ligation of the lingual artery: An anatomic study

Objectives. This article's purpose is to describe the variation in lingual artery position, review the anatomy and historical background of the smaller triangles of the anterior aspect of the neck, and discuss management of intraoral hemorrhage arising from the lingual artery.Study design. Ninety-one extraoral dissections of the submandibular region were performed on 54 human cadavers.Results. Pirogoff's triangle was present in 58.2% of the cases. The lingual artery was inferior to the digastric tendon in 67% and 6.3 mm (±3.9 mm) superior to the hyoid bone. The lingual artery was inferior to the hypoglossal nerve in 84.6%, directly deep to the nerve in 11%, and superior to the nerve in 4.4%.Conclusions. The lingual artery and hypoglossal nerve were more inferior than classically described. This finding suggests the need for a refinement of the extraoral ligation procedure, in which the facial artery is ligated first, and then, if necessary, the lingual artery is clamped and tied.

Maxillofacial plasmacytoma resulting in intraoral hemorrhage in a patient with multiple myeloma

Oral symptoms of multiple myeloma are common. A patient with refractory multiple myeloma is described because of this unusual orofacial manifestations, including severe intraoral hemorrhage, a massive, erosive maxillofacial lesion with extension into the cranial fossa, and rapid growth of a large intraoral mass.

高感度ヘモグロビン測定法による口腔内出血の定量的分析 ＩＩ 感度の増大とサンプル調製のための新しい含そう法の開発

Since 1966, the cyanmethemoglobin method has been the internationally standardized method for determination of hemoglobin in blood.However this method is not suitable for determination of low concentrations of hemoglobin in saliva. Recently we devised a modified cyanmethemoglobin method for determination of low concentrations of hemoglobin. In this method, absorption maximum at 420nm having high molecular extinction coefficient was chosen, and sample volume was increased ten-fold.In the present study, sensitivity was further incresed by a 100-fold increase in sample volume. Thus, hemoglobin concentration could be correctly determined even in 10, 000-fold diluted blood with saline. The use of half-diluted saliva as a diluent showed very little effect on the values of hemoglobin concentration.For quantitative analysis of intraoral hemorrhage, we adopted a gargling method; after letting a patient gargle with 3 ml of physiological saline for 15 sec, and the saliva mixed with the saline was obtained for hemoglobin assay. Patiens easily understood the method after brief explanations, and approximately the same volumes of the sample as the initial saline were recovered after gargling. The sample could be stored for 12 hours at 5°C or 24 hours at-30°C without significant changes in hemoglobin concentration. The present method seems a good quantitaive analysis for intraoral hemorrhage.

高感度ヘモグロビン測定法による口こう内出血の定量的解析

Hemostatic condition after oral surgery is now confirmed by subjective methods such as visual observation or listening to patient's complaints. Quantitative analysis of intraoral hemorrhage, however is desirable for the postoperative managment, especially in cases of hemophilia or other coagulopathies. Although determination of hemoglobin concentration in saliva is useful for this purpose, the cyanmethemoglobin method, the internationally standardized method for the determination of hemoglobin in blood, is not suitable for the determination of low concentration of hemoglobin. In this study, a modified cyanmethemoglobin method was devised for the determination of low concentration of hemoglobin. An absorption maximum at 420nm having high molecular extinction coefficient was chosen for the determination of cyanmethemoglobin concentration in the present method, and sample volume was increased ten-fold. Thus, the sensitivity was increased approximately 100-fold in this method, and hemoglobin concentration could be correctly determined even in 1000-fold diluted blood with saline. The use of half-diluted saliva as a diluent showed a little effect on the values of hemoglobin concentration. Although further study is necessary for sampling and/or storage of saliva contaminated with blood, the present method appears to be useful for quantitative analysis of intraoral hemorrhage.