Hematoma of the floor of the mouth and airway obstruction during mandibular dental implant placement: a case report

Abstract

The floor of the mouth is richly vascularized by a number of branches of the submental and sublingual arteries. During a dental implant procedure in the anterior zone of the mandible, perforation of the lingual cortex may invade the floor of the mouth and therefore damage structures within the sublingual space. The anatomy of the lower portion of the anterior mandibular zone, with the mylohyoid ridge, makes it particularly vulnerable to this kind of injury, particularly in patients with atrophic mandibles. Only a few cases have been reported in the literature to date.

A new method for displaying the lingual artery using high-resolution three-dimensional phase-contrast magnetic resonance angiography

“…[1][2][3] Bleeding, which potentially leads to fatal airway obstruction, can result from damage to the lingual or facial arterial branches. Many studies have examined the vessels in human cadavers to clarify the variations in the vessels.…”

“…The recent increase in dental implant treatment has resulted in an increased incidence of complications. [1][2][3] Therefore, obtaining prior image information on the lingual and sublingual arteries and their relation to the adjacent structures is very useful for surgeons performing maxillofacial surgery.…”

Altered Position of the Medial Lingual Nutritional Foramina at Different Stages of Alveolar Ridge Atrophy

“…Intraoperative complications related to surgery include hemorrhages, neurosensory alterations, damaged teeth adjacent to the implant, and mandibular fractures. [17][18][19][20][21] A hematoma of the floor of the mouth is a rare but potentially life-threatening condition that requires immediate treatment. It can even lead to a very serious airway obstruction.…”

“…11,18,20,21 An acute hemorrhage is controlled by strong finger pressure at the point of bleeding, infiltration by a vasoconstrictor, or ligation. 11,[17][18][19][20][21] Aspiration or drainage is not recommended as it can increase the bleeding and limit the selftamponading action by the hematoma itself. 17 Besides sufficient surgical training and anatomic knowledge, preventive measures to avoid such hemorrhages include preoperative assessment of osseous morphology on imaging and physical examination, with a special focus on the grade of atrophy.…”

“…11,[17][18][19][20][21] Aspiration or drainage is not recommended as it can increase the bleeding and limit the selftamponading action by the hematoma itself. 17 Besides sufficient surgical training and anatomic knowledge, preventive measures to avoid such hemorrhages include preoperative assessment of osseous morphology on imaging and physical examination, with a special focus on the grade of atrophy. Thus, surgeons should keep in mind that the grade of atrophy correlates with the position of the medial lingual nutritional foramina.…”