Sublingual Hematoma Research Articles

Submandibular fossa augmentation in implant dentistry.

Background:There are two limiting factors for determining the dental implant fixture length in mandibular posterior edentulous region: Inferior dental canal and submandibular fossa.Purpose:Submandibular fossa augmentation is a suggested way to overcome the problem of lingual undercut beneath the mylohyoid ridge in implant dentistry.Materials and Methods:Patients with lingual posterior bony undercut that interferes with the placement of a standard implant with a length of 10 mm were enrolled in this study.Results:This method was used for eight patients in 10 sites. Increased implant length and decreasing the chance of sublingual hematoma due to lingual cortical plate perforation are the results of this study.Conclusions:Submandibular fossa augmentation is a new technique to improve the maneuver of oral surgeons to increase dental implant length in the presence of deep lingual bony undercut.

Spontaneous sublingual haematoma in acquired haemophilia: case report

Acquired haemophilia is a rare disease in which bleeding is more severe than in hereditary haemophilia and usually occurs in the soft tissues, the gastrointestinal tract, or the mucous membranes. There have been only a few presentations of spontaneous sublingual haematoma in acquired haemophilia, but prompt management of the airway and identification of the underlying cause was crucial in all.

Unusual Coexistence of Giant Cell Tumor and Small Bone Tuberculosis of the Hand - A Case Report

The sublingual hematoma is the cause of bleeding and swelling under the tongue it is commonly seen in the people after some kind of tooth surgery or implant or it can commonly see in the people after a mouth or tongue injury.

Minimally traumatic submental intubation: a novel dilational technique.

Submental intubation is widely accepted as a safe and effective alternative to nasal intubation or tracheostomy in head and neck surgery patients. Forceful or careless technique can cause significant bleeding and trauma to the soft tissues at this point, increasing the likelihood of troublesome sublingual haematoma. We describe the use of a percutaneous tracheostomy horn (Cook Medical Blue Rhino®) to allow minimally traumatic submental intubation without the need for serial dilations. A patient with severe midfacial injuries requiring surgery was intubated via a standard oral technique. Following this, submental access was achieved using a novel dilational technique with a tracheostomy dilator. This resulted in a very secure and safe submental intubation and unrestricted access to the entire surgical field. The single instrument, one-pass dilation technique to achieve submental intubation was found to be easy, quick, and avoided excessive trauma to the floor of mouth. Patients will sometimes require a protected airway that allows surgeons unrestricted and simultaneous access to the dental occlusion, oral cavity, midface, and nose. In our case, this simple, easy, and quick adaptation of an established technique using a tracheostomy dilator is an excellent alternative to the traditional blunt dissection used to achieve submental intubation.

Unusual Site Hemorrhagic Complications of Anticoagulantion

AbstractAnticoagulation has inherent quality to produce bleeding complications, more frequently in the elderly. Usual sites following anticoagulation is gastrointestinal, nasal, intracranial hemorrhage or petechial bleed. Here were reporting unusual sites of anticoagulation induced bleed. Rectus sheath hematoma is an unusual bleeding site, can mimic acute abdomen. Bleeding into intestinal wall can produce intussusception and presentation will be again as acute abdomen. Similarly, Sub lingual space is an unexpected site of bleeding and can present as upper airway obstruction or esophageal obstruction. Here we report one case of rectal sheath hematoma, 2 cases of sublingual hematoma and one case in the intestinal wall hematoma due to oral anticoagulation.

Two Cases of Sublingual Hematoma as a Manifestation of Child Abuse

Common intraoral manifestations of child abuse include tears of the frenula, burns, and pharyngeal perforations. Sublingual hematomas can also occur as a result of trauma, but to the best of our knowledge, only 1 case has been previously described in the context of child abuse. We report 2 new cases of sublingual hematoma in infants that were the result of physical abuse. Cases of sublingual hematoma in infants and children without a clear and legitimate explanation of the cause should prompt consideration of child abuse.

Epidemiological, Clinical and Pathological Features in Anticoagulant Rodenticide Toxicosis in Dogs: 66 Cases (2010-2015)

Anticoagulant rodenticides are widely used pesticides globally. They act by inhibiting vitamin K epoxide reductase in the liver, decreasing the synthesis of clotting factors II, VII, IX, and X. Sixty six cases of anticoagulant rodenticide toxicosis were found during a retrospective study conducted at the Veterinary Hospital and the Pathology Department of the Faculty of Veterinary Medicine Cluj-Napoca, in a period between January 2010 and June 2015.The inclusion criteria were: clinical signs of exposure, coagulation testing result and typical pathological findings characteristic for bleeding syndrome. History, clinical and pathological data were collected from the medical records of the dogs presented to our units. In the present study, 66 cases of anticoagulant toxicosis in dogs were described, the animals ranging in age from 2 months to 12 years. 31 dogs were male and 35 female. Two cases followed exposure to brodifacoum, 4 cases exposure to warfarin and in the other cases the type of anticoagulant was unknown. The most common clinical signs were dyspnea, lethargy, weakness, anemia/palor, melena, spontaneous subcutaneous and muscular hematoma, sublingual hematoma and ecchymoses. The most important lesions were represented by haemothorax, thymic hematoma in juvenile dogs, subcutaneous and muscular hematomas, hemoperitoneum, severe anemia, and ecchymotic hemorrhages in different tissues. In cases were coagulation testing was performed, prolonged partial thromboplastin time, prothrombin time and coagulation time were recorded. Anticoagulant rodenticide toxicosis is frequently found in our region, the most important diagnostic tools being coagulation testing and toxicological exam.

Management of pain and sublingual hematoma caused by suture irritation after implant surgery: A clinical report

Hematoma in the sublingual region is an adverse consequence of implant surgery in the mandibular posterior region. Improved knowledge and understanding of the anatomy as well as the use of advanced radiographic imaging have all contributed to minimizing adverse surgical complications in this region. Delayed sublingual hematoma caused by suture irritation after implant surgery has not previously been reported. This article describes the management of a patient with a delayed sublingual hematoma after implant surgery in the posterior mandible had been performed. No evidence of encroachment of the vascular structures was noted at the time of implant surgery. However, at a 48-hour follow-up, the patient presented with severe pain and irritation of the sublingual mucosa, along with extravasation and a collection of blood in the sublingual region. Based on the patient’s symptoms and clinical signs, the source of the problem was determined to be the stiff tags of polypropylene suture, which had been used to attain primary closure of the surgical flaps. The situation was conservatively and successfully managed by the use of a custom soft tissue guard to protect the patient’s sublingual mucosa and the tongue from the stiff suture tags. Various suture materials and measures for preventing and managing similar situations are discussed in this article.

Spontaneous Lingual Hematoma: A Rare Entity

There are case reports of spontaneous sublingual and lingual hematomas in the elderly population related to severe hypertension or an anticoagulation therapy. Spontaneous lingual hematoma is a rare entity in patients without risk factors for bleeding. We present the first case described in the literature of a spontaneous lingual hematoma in a woman in the age of early fifties without diabetes mellitus, trauma, hematological disorders, hypertension, anticoagulant or thrombolytic associated therapies. The patient required analgesic treatment and recovered spontaneously within a week.

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use.

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Massive Lingual and Sublingual Haematoma following Postextractive Flapless Implant Placement in the Anterior Mandible

Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases.

Perioral and sublingual hematoma: Oral anticoagulation therapy complication: Case study

Introduction. Anticoagulation therapy includes drugs which prevent intravascular formation and spreading of a thrombus. Heparin and dicoumarin preparation are in use. Heparin preparations are commonly used when a rapid anticoagulant effect is required, they are administered intravenously, act immediately performing the inhibition of thromboplastin activation, prothrombin to thrombin conversion, and the effect of thrombin to fibrinogen. Oral anticoagulation therapy (OAT) includes drugs - antagonists of vitamin K, which is responsible for the synthesis of prothrombin complex factors - II, VII, IX and X. They are derived from coumarin and indandione. One of the most frequently used drugs from the OAT group is warfarin. It is a competitive inhibitor of vitamin K required for the carboxylation of the residues of PK factor glutamic acid. The results of this inhibition lead to the unsuccessful formation of gama carboxyglutamic acid and the production of functionally inert coagulation proteins. The aim of this study was to show a rare but dangerous complication of an inadequate application of oral anticoagulation therapy. Case study. Patient S.S., male, aged 79, was admitted to the Oral Surgery Department, Clinic of Dentistry of the Faculty of Medicine in Niš on October 5, 2012 due to a severe general condition with massive hematoma in the facial area. Anamnestic data showed that during the previous couple of days, the patient was voluntarily taking a whole tablet of Farin instead of the prescribed dose. The patient started receiving intravenous low-molecular-weight heparin therapy (Fraxarin 0.3/12h) along with the antibiotic therapy. In the following period, the patient reported daily at the Oral Surgery Department for regular check-ups. The hematoma was absorbed and the swelling was completely gone within the next 7 to 10 days.

Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases.

Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.

Warfarin induced sublingual hematoma: a Ludwig angina mimic

BackgroundSublingual hematoma is a rare but life-threatening complication of oral anticoagulants. It is important to differentiate this from infectious processes like Ludwig's angina. Securing the airway should be a priority and immediate reversal of anticoagulation with close monitoring is required. Case reportWe present a case of sublingual hematoma secondary to warfarin therapy without airway compromise which was managed conservatively with reversal of INR with oral vitamin K. ConclusionAlthough rare, it is crucial to differentiate sublingual hematomas from infectious processes. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise is the treatment of choice.

Transsubmental tongue‐base suspension in treating patients with severe obstructive sleep apnoea after failed uvulopalatopharyngoplasty: Our Experience

Dear Editor, Snoring and obstructive sleep apnoea is largely owing to narrowed upper airway and abnormal collapsibility during sleep. More than 90% of apneic patients have single obstruction in the retropalatal level, whereas 40–50% of those have obstruction in multiple sites, including retropalatal space, retrolingual space and hypopharynx. 1 Successful surgical management of obstructive sleep apnoea requires various procedures to address these multiple levels of airway obstruction. Although uvulopalatopharyngoplasty is commonly performed in treating snoring or obstructive sleep apnoea patients, the success rate of uvulopalatopharyngoplasty is as low as 5–10% in severe obstructive sleep apnoea patients with retrolingual obstruction. 2 Traditional tongue-base suspension with Repose System (Metronic Xomed, Jacksonville, FL, USA), first described by DeRowe et al., 3 is a minimally invasive surgery to prevent retrolingual collapse during sleep. However, the effectiveness of tongue-base suspension in treating severe obstructive sleep apnoea patients with failed uvulopalatopharyngoplasty remains unexplored. Additionally, traditional tongue-base suspension with the transoral approach causes significant postoperative morbidity, e.g., teeth numbness, sialoadenitis, sublingual hematoma and sublingual gland obstruction. 3 The aim of this study is to investigate the role of newly designed transsubmental tongue-base suspension in treating severe obstructive sleep apnoea patients while uvulopalatopharyngoplasty has failed. Exactly how the sleep position affects the efficacy of transsubmental tongue-base suspension is also analysed. Patients and methods

Trauma and Sharp tooth induced labial vestibule hematoma in a patient with elevated International normalized ratio

Summary: Haemostasis is a defence mechanism that protects vascular integrity, avoids blood loss, and maintains blood fluidity throughout the circulatory system. Per oral hematoma secondary to anticoagulation is a rare fatal condition. Haemorrhagic complications of warfarin therapy are well known.In any case, the most important concern is the prevention of bleeding complications by compiling a detailed clinical history, with adequate planning of treatment, and taking special care to avoid soft tissue damage during the dental treatment of such patients. Only occasional reports state sublingual and labial vestibule hematoma formation as a result of deficient coagulation. This particular case is very unique in that the patient was on warfarin for the past 3 years but did not develop any hematoma. However trauma by fall triggered the episode of sublingual and buccal vestibular hematoma in this patient. The patient was managed by temporarily stopping warfarin for 4 days and transfusing 2 units of fresh frozen plasma. Tab. Warfarin was restarted after 4 days on alternate days and INR dropped to 2. The sharp cusp of the mandibular tooth was smoothened to prevent ulcer development. The hematoma resolved and no new hematoma formation was observed for a period of 6 months.

Life-Threatening Expansive Sublingual Hematoma

Vascular injuries are a constant risk in facial trauma, although bone and soft tissues of the face have provided some protection to the larger blood vessels. However, penetrating injuries usually do not have this type of protection and can damage significant vascular arteries. This article presents a case of a stab wound, which led to airway obstruction arising to a large sublingual hematoma due to lingual artery injury. A healthy 44-year-old man was stabbed in the submandibular region and admitted with an airway obstruction. He was subjected to an emergency tracheotomy and evolved with progressive sublingual edema. Computed tomography (CT) angiography showed a left lingual artery injury with the formation of an expansive hematoma. The CT angiography findings helped to identify the cause of the hematoma and guided the surgery to drain the hematoma after ligation of the lingual artery. The treatment was safely performed as planned and evolved uneventfully. The patient recovered fast and well and presented normal functions 6 months after the treatment. This surgical technique is an effective method for treating such injuries because it can be safely performed when guided by CT angiography. The authors argue that the demand for vascular lesions should be routine in patients who have facial trauma.

Stab wound leading to sub lingual haematoma

We report a case of a sublingual haematoma and proptosis of the right eye as a result of penetrative injury to the suprazy-gomatic supratemporal fossa. The case was seen in the accident and emergency department at the Royal London Hospital (RLH). The case was referred to the anaesthetic and oral and maxillofacial unit, following neurosurgery and ophthalmology assessments.The case highlights the need for a multi disciplinary approach to dealing with penetrative wounds in the craniofacial region. It is essential that all healthcare professionals have excellent working knowledge of the anatomy of the orbit and its asso-ciation with anatomical planes in the head and neck. (1) When diagnosing orbital compartment syndrome (also known as retrobulbar haemorrhage), radiographic findings should always be correlated to clinical signs and symptoms. Management of such a condition should be tailored to the individual. In this case medical management alone of 80mg of dexamethasone and 500mg of Mannitol was appropriate to enable a full recovery.

Infected Sublingual Hematoma: A Rare Complication of Frenulectomy

Infected Sublingual Hematoma: A Rare Complication of Frenulectomy

When Is "Pseudo-Ludwig's Angina" Associated With Coagulopathy Also a "Pseudo" Hemorrhage?

Sublingual hematoma secondary to short-acting anticoagulants such as warfarin has been labeled “pseudo–Ludwig’s angina” to distinguish it from the classic syndrome of localized infection and swelling involving the upper airway. Sublingual hematoma with airway compromise secondary to brodifacoum, a common long-acting anticoagulant rodenticide, has only been reported in the veterinary literature. We report a case of massive tongue swelling and impending airway compromise in the context of an intentional long-acting anticoagulant ingestion leading to coagulopathy. The swelling was initially presumed to be due either to infection or hemorrhage, but this was not supported by computed tomography scan imaging. Instead, the patient’s clinical course was consistent with corticosteroid-responsive angioedema, temporally associated with the ingested brodifacoum.