A case of posterior superior alveolar artery damage caused by local anesthesia in the maxillary third molar region

Abstract

We report a case of posterior superior alveolar artery damage caused by local anesthesia in which hemostasis was achieved by transcatheter arterial embolization. The patient was a 50-year-old woman who received local anesthesia for extraction of the maxillary left third molar at a dental clinic. Immediately after delivery of the local anesthetic, a swelling developed on the left side of her face, and the extraction procedure was cancelled. However, the swelling and pain increased; therefore, she was referred to our department. Swelling with dark-colored petechiae were observed from the left periorbital region to the submandibular region, associated with severe pain. Contrast-enhanced computed tomography (CT) and three-dimensional CT angiography suggested bleeding from the posterior superior alveolar artery. The swelling progressed despite pressure hemostasis at the site of arterial injury. Therefore, angiography was performed after consultation with a radiologist. Leakage of the contrast agent from the posterior superior alveolar artery was confirmed, and embolization of the artery using a gelatin sponge was performed. After the procedure, hemostasis was achieved, and bleeding did not recur. The swelling improved within a few days without any complications. Clinicians should consider the possibility of arterial injury caused by local anesthesia for dental procedures and take the necessary precautions. : local anesthesia (局所麻酔) ，hematoma (血腫) ，transcatheter arterial embolization (TAE) (経カテーテル 的動脈塞栓術) ，posterior superior alveolar artery (後上歯槽動脈) 奈良県立医科大学口腔外科学講座 (主任：桐田忠昭教授)

Hematoma subcutâneo em face durante procedimento cirúrgico oral: relato de caso

“…A resolução do quadro ocorre gradualmente, envolvendo descoloração do hematoma e involução do edema, que ocorre entre 7 e 15 dias. 1,13 O hematoma exerce tensão nos tecidos adjacentes, diminuição da vascularização e há formação de espaço morto na distensão dos tecidos, o que torna a região um meio de cultura para infecções bacterianas, sendo necessário em alguns casos antibioticoterapia. 10,13 Episódios de trismo e dor podem estar associados ao hematoma e, estes, devem ser tratados por meio do uso de anti-inflamatórios não-esteroidais e analgésicos.…”