Kalpidis Christos D R, Setayesh Reza M
Department of Periodontology and Oral Biology, Boston University, Goldman School of Dental Medicine, Boston, MA, USA.
J Periodontol. 2004 May;75(5):631-45. doi: 10.1902/jop.2004.75.5.631.
The placement of endosseous dental implants is largely considered a safe surgical procedure. However, upper airway obstruction secondary to severe bleeding in the floor of the mouth has been occasionally reported as a rare but potentially fatal complication of implant surgery. This review presents critical hemorrhagic episodes, related to dental implantation in the anterior segments of the mandible, published to date. Massive internal bleeding in the highly vascularized region of the floor of the mouth is the result of an arterial trauma induced by instrumentation, usually through a perforation of the lingual cortical plate. Depending on the clinical situation, hemorrhage may commence immediately or with some delay after the vascular insult. The progressively expanding lingual, sublingual, submandibular, and submental hematomas have the tendency of displacing the tongue and floor of the mouth to obstruct the airway. Because the course of airway deterioration to complete occlusion may be rapid, ensuring a patent airway is of highest priority. Even though upper airway obstruction is potentially life-threatening, a secure airway was successfully established in all patients without fatal consequences. In most cases, resolution of hemorrhage required a surgical intervention for ligation of the bleeding vessels and hematoma evacuation. To reduce the probability of such a grave complication, preventive and precautionary measures to be taken before, during, and after implant placement in the anterior mandible are presented. Issues related to the level of surgical experience, fine regional arterial anatomy, radiographic and clinical evaluation of the osseous morphology, angulation and length of implants, and timing of hemorrhage onset are discussed. In addition, airway and bleeding management strategies are provided.
骨内牙种植体植入术在很大程度上被认为是一种安全的外科手术。然而，偶尔有报告称，口底严重出血继发上呼吸道梗阻是种植手术罕见但可能致命的并发症。本综述介绍了迄今为止已发表的与下颌前部牙种植相关的严重出血事件。口底血管高度丰富区域的大量内出血是器械操作导致动脉损伤的结果，通常是通过舌皮质板穿孔。根据临床情况，出血可能在血管损伤后立即开始，也可能延迟一段时间。逐渐扩大的舌、舌下、颌下和颏下血肿有使舌和口底移位从而阻塞气道的倾向。由于气道恶化至完全阻塞的过程可能很快，确保气道通畅是最优先考虑的事项。尽管上呼吸道梗阻可能危及生命，但所有患者均成功建立了安全气道，未出现致命后果。在大多数情况下，出血的解决需要手术干预以结扎出血血管并清除血肿。为降低这种严重并发症的发生概率，本文介绍了在下颌前部种植体植入前、植入期间和植入后应采取的预防措施。讨论了与手术经验水平、精细的局部动脉解剖结构、骨形态的影像学和临床评估、种植体的角度和长度以及出血开始时间相关的问题。此外，还提供了气道和出血管理策略。
