Life-threatening airway obstruction after flapless implant placement in the anterior mandible

Abstract

(J Korean Assoc Oral Maxillofac Surg 2012;38:310-3) This paper reports a patient who had an airway obstruction caused by a hemorrhage of the mouth floor that occurred after she underwent flapless implantation in the region of the mandibular anterior teeth. The hemorrhage may have been caused by iatrogenic malpositioned fixture and patient's hypertension. The lingual periosteum was not dissected during the flapless procedure. Therefore, when hemorrhage occurred, the blood did not drain easily into the oral cavity but instead drained into the deep neck region, which might have been the cause of the airway obstruction. Key words: Airway obstruction, Dental implants[paper submitted 2011. 11. 24 / accepted 2012. 2. 20] II. Case ReportA 56-year-old female patient came to the emergency room (ER) with chief complaint of dyspnea due to swollen tongue and neck. The medical history was remarkable for hypertension. The dental history showed that, earlier on the day of her visit to the ER, the patient had undergone at a local dental clinic extraction of both lower central incisors followed immediately by flapless implantation. According to the patient's history of chief complaint, there was continuous oozing around the surgical site after the implant was installed at around 3 pm that day. Her dentist could not give her an acceptable explanation for her condition, so the patient visited the ER at 10:30 pm with the swelling aggregated around her neck area.The patient said her symptoms of edema and dyspnea had begun on the AMF after the implantation. Clinical examination in the ER showed severe swelling of the AMF and tongue, accompanied by ecchymosis and orthopnea. The patient's respiration rate was 20 times per minute, and routine lab results including hemoglobin, T-CO 2 , and PT and aPTT were all within normal limits. Her SpO 2 was over 98%, and systolic and diastolic blood pressure (BP) in sitting position were 160 mmHg and 100 mmHg, respectively. Note, however, that the patient's vital signs worsened in the SemiFowler's and supine positions. A computed tomography (CT) of the neck could not be performed immediately after the