American Journal of Emergency Medicine xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Case Report
Extensive facial hematoma following third molar removal☆,☆☆
Abstract Third-molar extractions are among the most common surgical procedures performed by oral/maxillofacial surgeons. Post-operative complications, although uncommon are often managed by emergency physicians. We present a case of an elderly woman presenting to the emergency department with extensive facial hematoma with extension into the maxillary sinus. The patient required admission and was evaluated by the oral surgery and otolaryngology services before discharge home in stable condition. This case presents an overview of the emergency department diagnosis and management of hemorrhage following exodontia. A 90-year-old woman with a non-contributory past medical history on no anti-coagulation presented to the ED with a chief complaint of severe and progressive facial pain and swelling following a third molar dental extraction for suspected abscess performed several hours prior (Figs. 1 and 2). Upon physical examination, her vitals were unremarkable, and the airway was patent. The right side of the face was visibly swollen. The surgical wound of the third molar had been closed with absorbable sutures and was mildly bleeding. No purulent material was noted. The buccal mucosa was massively swollen and appeared as a large hematoma. After manual packing of the right side of the mouth with gauze failed to tamponade the bleeding, 2 mL of 1 % lidocaine with epinephrine was injected to the area, and the wound was re-packed . Computed tomography (CT) of the head and neck were obtained to further evaluate the extent of the presumed, extensive hematoma.
Fig. 1. Extensive Right-sided facial swelling and ecchymosis. ☆ This manuscript has not been previously presented or published. ☆☆ The authors report no conflict of interest related to this manuscript. E-mail address: [email protected] (C.K. Kraus).
Fig. 2. Coronal CT image demonstrating large hematoma from dental extraction cavity with extension into maxillary sinus and surrounding soft tissue.
CT showed a large hematoma (2.6 cm) from the dental extraction cavity with hemorrhage in the adjacent right masticator and buccal spaces. Third-molar extractions are among the most common surgical procedures performed by oral/maxillofacial surgeons [1]. Massive post-operative hemorrhage after extraction of the third-molar is extremely uncommon (less than 1.5 percent) [2,3]. Airway compromise requiring emergent management, significant blood loss anemia, and the need for angiographic embolization or surgical ligation can occur [4-6]. Patients with active hemorrhage following tooth extraction not easily controlled in the ED may require laboratory testing (CBC, coagulation studies), advanced imaging (such as contrast-enhanced CT), consultation with an oral surgeon, and admission to the hospital for additional observation and treatment. The patient was admitted and further evaluated by the oral surgery and otolaryngology services. Despite an almost 2 g/dL drop in hemoglobin, she remained hemodynamically stable throughout her admission. Repeat CT showed no additional expansion of the hematoma. The patient was discharged home on day three in stable condition with appropriate outpatient follow-up. Chadd K. Kraus DO, MPH Kenneth D. Katz MD Department of Emergency Medicine (CKK;KDK) and Section of Medical Toxicology (KDK) Lehigh Valley Health Network Allentown, PA, USA E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.02.031
Please cite this article as: Kraus CK, Katz KD, Extensive facial hematoma following third molar removal, Am J Emerg Med (2014), http://dx. doi.org/10.1016/j.ajem.2014.02.031
Q1
2
C.K. Kraus, K.D. Katz / American Journal of Emergency Medicine xxx (2014) xxx–xxx
References [1] Moghadam HG, Caminiti MF. Life-threatening hemorrhage after extraction of third molars:case report and management protocol. J Can Dent Assoc 2002;68(11):670–4. [2] Wells D, Capes J, Powers M. Complications of dentoalveolar surgery. In: Fonseca R, editor. Oral and maxillofacial surgery, Vol. 1. Philadelphia: WB Saunders; 2000. p. 421–38. [3] American Association of Oral and Maxillofacial Surgeons. Report of a workshop on the management of patients with third molar teeth. J Oral Maxillofac Surg 1994;52 (11):1102–12.
[4] Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2007;19(1):117–28, vii. [5] Wasson M, Ghodke B, Dillon JK. Exsanguinating hemorrhage following third molar extraction: report of a case and discussion of materials and methods in selective embolization. J Oral Maxillofac Surg 2012;70(10):2271–5. [6] Warburton G, Brahim JS. Intraorbital hematoma after removal of upper third molar: a case report. J Oral Maxillofac Surg 2006;64(4):700–4.
0735-6757/$ – see front matter © 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Kraus CK, Katz KD, Extensive facial hematoma following third molar removal, Am J Emerg Med (2014), http://dx. doi.org/10.1016/j.ajem.2014.02.031
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Case Report
Extensive facial hematoma following third molar removal☆,☆☆
Abstract Third-molar extractions are among the most common surgical procedures performed by oral/maxillofacial surgeons. Post-operative complications, although uncommon are often managed by emergency physicians. We present a case of an elderly woman presenting to the emergency department with extensive facial hematoma with extension into the maxillary sinus. The patient required admission and was evaluated by the oral surgery and otolaryngology services before discharge home in stable condition. This case presents an overview of the emergency department diagnosis and management of hemorrhage following exodontia. A 90-year-old woman with a non-contributory past medical history on no anti-coagulation presented to the ED with a chief complaint of severe and progressive facial pain and swelling following a third molar dental extraction for suspected abscess performed several hours prior (Figs. 1 and 2). Upon physical examination, her vitals were unremarkable, and the airway was patent. The right side of the face was visibly swollen. The surgical wound of the third molar had been closed with absorbable sutures and was mildly bleeding. No purulent material was noted. The buccal mucosa was massively swollen and appeared as a large hematoma. After manual packing of the right side of the mouth with gauze failed to tamponade the bleeding, 2 mL of 1 % lidocaine with epinephrine was injected to the area, and the wound was re-packed . Computed tomography (CT) of the head and neck were obtained to further evaluate the extent of the presumed, extensive hematoma.
Fig. 1. Extensive Right-sided facial swelling and ecchymosis. ☆ This manuscript has not been previously presented or published. ☆☆ The authors report no conflict of interest related to this manuscript. E-mail address: [email protected] (C.K. Kraus).
Fig. 2. Coronal CT image demonstrating large hematoma from dental extraction cavity with extension into maxillary sinus and surrounding soft tissue.
CT showed a large hematoma (2.6 cm) from the dental extraction cavity with hemorrhage in the adjacent right masticator and buccal spaces. Third-molar extractions are among the most common surgical procedures performed by oral/maxillofacial surgeons [1]. Massive post-operative hemorrhage after extraction of the third-molar is extremely uncommon (less than 1.5 percent) [2,3]. Airway compromise requiring emergent management, significant blood loss anemia, and the need for angiographic embolization or surgical ligation can occur [4-6]. Patients with active hemorrhage following tooth extraction not easily controlled in the ED may require laboratory testing (CBC, coagulation studies), advanced imaging (such as contrast-enhanced CT), consultation with an oral surgeon, and admission to the hospital for additional observation and treatment. The patient was admitted and further evaluated by the oral surgery and otolaryngology services. Despite an almost 2 g/dL drop in hemoglobin, she remained hemodynamically stable throughout her admission. Repeat CT showed no additional expansion of the hematoma. The patient was discharged home on day three in stable condition with appropriate outpatient follow-up. Chadd K. Kraus DO, MPH Kenneth D. Katz MD Department of Emergency Medicine (CKK;KDK) and Section of Medical Toxicology (KDK) Lehigh Valley Health Network Allentown, PA, USA E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.02.031
Please cite this article as: Kraus CK, Katz KD, Extensive facial hematoma following third molar removal, Am J Emerg Med (2014), http://dx. doi.org/10.1016/j.ajem.2014.02.031
Q1
2
C.K. Kraus, K.D. Katz / American Journal of Emergency Medicine xxx (2014) xxx–xxx
References [1] Moghadam HG, Caminiti MF. Life-threatening hemorrhage after extraction of third molars:case report and management protocol. J Can Dent Assoc 2002;68(11):670–4. [2] Wells D, Capes J, Powers M. Complications of dentoalveolar surgery. In: Fonseca R, editor. Oral and maxillofacial surgery, Vol. 1. Philadelphia: WB Saunders; 2000. p. 421–38. [3] American Association of Oral and Maxillofacial Surgeons. Report of a workshop on the management of patients with third molar teeth. J Oral Maxillofac Surg 1994;52 (11):1102–12.
[4] Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2007;19(1):117–28, vii. [5] Wasson M, Ghodke B, Dillon JK. Exsanguinating hemorrhage following third molar extraction: report of a case and discussion of materials and methods in selective embolization. J Oral Maxillofac Surg 2012;70(10):2271–5. [6] Warburton G, Brahim JS. Intraorbital hematoma after removal of upper third molar: a case report. J Oral Maxillofac Surg 2006;64(4):700–4.
0735-6757/$ – see front matter © 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Kraus CK, Katz KD, Extensive facial hematoma following third molar removal, Am J Emerg Med (2014), http://dx. doi.org/10.1016/j.ajem.2014.02.031
