<p>Floor of the mouth hemorrhage subsequent to dental implant placement in the anterior mandible</p>

Abstract

Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient’s complications are reviewed. One patient had immediate hematoma formation while the other developed a hematoma overnight, presenting the next day. The treatment rendered was a precautionary in-hospital tracheotomy for the first patient and only compression control for the second. Bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx. In-hospital treatment may be necessary to prevent an adverse outcome. It must be noted that a hematoma in the submandibular space is life threatening by direct airway compression.

Life-threatening sublingual hematoma after mandibular implant placement - A case report

“…In stable hematomas, some authors take observational measures and others perform intubation and/or tracheostomy. [ 2 6 9 ] In our patient, our own proposed guidelines were not strictly followed, and tracheostomy decision was influenced by the absence of a head and neck surgeon on duty at the hospital. Given the case of a nonprogressive hematoma, a Guedel pattern airway or a laryngeal mask would have achieved normal oxygenation but, in case of bleeding reactivation, emergency tracheostomy would have been necessary.…”

“…Lateral canals may also be present. [ 6 ] Recent studies have described anatomical variants that are intrinsically related with this complication. The submental artery (branch of the facial artery) frequently gives off a branch that reaches the floor of the mouth and sometimes is the only vascular source to the area.…”

“…Several cases have been reported during or after implant placement in the interforaminal mandible[ 1 2 3 4 5 6 ] due to lingual cortex perforation by involuntary drilling, poor planification, or excessive implant angulation. Intraosseous arterial injury may also overcome with long implants in atrophic mandibles.…”

Risk Assessment of Lingual Plate Perforation in Anterior Edentulous Mandibular Region: A Virtual Implant Placement Study Using Cone-Beam Computed Tomography

“…Perforations that may occur in the lingual vessels during osteotomy may cause severe bleeding and upper airway obstruction. 7,17 CBCT is accepted as the gold standard in determining the morphology of the bone and the localization of important anatomical structures when planning before implant surgery. 1,13 However, access to this imaging technique is not possible in many clinics, and a two-dimensional evaluation is performed on OPG.…”

Investigation the anterior mandibular lingual concavity by using cone-beam computed tomography

“…The perforation in lingual cortex and consequently a vascular damage may develop in this region during dental implant placement or other surgical interventions, especially in presence of concavity. The severe hemorrhage, upper respiratory tract obstruction and hematoma on the mouth floor may develop as a result of the vascular damage [3,[5][6][7][8]. Up to 24% of hemorrhage complications have been reported after implant placement [9].…”